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Infant Feeding
For Baby | For Mother
FOR BABY…
1. Mother’s milk is produced three days after giving birth. What should the newborn be fed on in the meantime?
The baby feeds on colostrum till ‘actual milk’ is produced by the mother two to three days after birth. A newborn must be encouraged to suckle within an hour after birth, stimulating the breast to produce the all-important colostrum. Colostrum is the thick yellow milk the mother produces immediately after birth.

2. But why is colostrum so important?
This form of milk delivers nutrients to the newborn in a very concentrated form and in tiny, digestible quantities. Colostrum contains all the nutrients the baby needs and is especially rich in proteins and vitamins.

In addition, it contains several growth factors which stimulate the development of the neonate’s gut.

It also provides the newborn with immunity as it contains antibodies and antibacterial agents from the mother. This is the first protection against life-threatening infections.

Colostrum contains immunuglobulins which coat the lining of the newborn’s immature intestine and thus prevent large protein molecules from entering the blood and circulatory system. This protects the neonate from developing allergic disorders such as asthma and eczema later in life.

Among its many functions, colostrum also acts as a mild laxative. It encourages the passage of the first stool or meconium. It is important that the neonate passes a stool soon after birth as it clears excess bilirubin, a waste product of dead red blood cells produced in large quantities at birth. This helps prevent jaundice.

3. When should a baby have his / her first feed?
Let us first understand how breast milk is produced and made available during the suckling process. Breast milk is produced in the milk-producing apparatus (alveoli) inside the breast. When the baby suckles, the mother produces a hormone that stimulates milk production. As suckling continues, she produces another hormone, which makes the milk descend from the alveoli to the dilated milk ducts (lactiferous sinuses), which are under the areole (dark skin around the nipple).

Starting breastfeeding immediately after delivery stimulates the production of these hormones and therefore the production of milk.

Breastfeeding should begin not later than an hour after birth. Babies delivered by Caesarean Section are put to breastfeed 4 hours later even of the mother is on an intravenous drip.

4. Should newborns be fed water, honey, glucose water or artificial milk in the first few days?
Feeds given to a newborn in the first few days, before the mother starts producing ‘actual’ milk, are called pre-lacteal feeds. They could be dangerous to both newborn and mother. This is because:
- if the newborn’s stomach is full, it may not suckle and receive vital colostrum
- pre-lacteal feeds may be contaminated and cause infections
- they may result in breastfeeding failure as the mother’s mammary glands will mot get sufficient stimulation to produce milk

5. Should breastfeeding be supplemented with water, fruit juice, soup, artificial milk, gripe water, cereals and vitamins in the first 4-6 months?
Breast milk is all a baby needs in the first 6 months. Anything else is inferior and may, in fact, prove harmful. And no matter what the packaging on baby food says, breast milk provides sufficient protection against diarrhea, coughs, colds and other common illnesses.

Also, breast milk provides the baby with sufficient water, even in hot and dry climates. Besides, a newborn may not be able to tolerate foods other than breast milk.

Mothers who are concerned about their babies receiving sufficient vitamins may take multivitamins themselves after consulting their physicians. Do not feed them to your baby.

Gripe water often contains alcohol and is therefore not advised.

6. If a baby must be given milk other than breast milk, what are the options?
In extreme circumstances, some babies may need to be fed artificial milk as may be the case with an adopted baby who hasn’t learnt to breastfeed or a baby whose mother may have died in childbirth. In such cases, liquid milk is preferred over powdered milk. For details, consult your physician.

7. How do you know if your baby is getting sufficient breast milk?
If you’re baby is being fed only breast milk (and no water), and at least urinates 6 times in 24 hours, this indicates he / she is receiving sufficient water. Breastfed children show normal weight gain and have a happy disposition.

8. Is weight gain a good indicator of whether the baby is getting enough breast milk?
Yes. However, some mothers wrongly assume that a baby must gain as much as two pounds or one kilo a month. Some normal babies may gain only half of that.

9. Are there drugs that increase the production of breast milk?
Frequent suckling is bound to simulate the mammary glands to produce sufficient milk. That’s why there is no reason to feed a baby with a bottle. Bottle-fed babies naturally suckle less and this is bound to discourage milk production. But, yes, there are some drugs such as Metoclopramide that may increase milk supply.

10. Can twins or premature babies be also fed adequately on breast milk?
Frequent suckling can produce enough milk for two babies. In the case of twins, the best course is to let one baby feed from one breast and the second from the other. Babies who can swallow but cannot suck are given expressed milk from a cup. It is better than spoon feeding and there is no risk of aspiration. Babies who are too weak to swallow are fed expressed milk through a stomach tube.

11. Is it true that some babies may get diarrhoea and may vomit with breast milk?
Not true. Breast milk is what nature intended babies to feed on and is therefore completely safe. Some exclusively breast-fed babies frequently pass watery stools, at times green or with mucous, and others sometimes vomit curd or milk. But if they are normal and active and frequently pass urine, no treatment is required and breastfeeding should continue.

Alternatively, some normal, thriving babies pass a stool once every four or five days. If the stools are not hard, this should not be considered constipation.

12. When should foods other than breast milk be added to the baby’s diet?
Ideally between 5 and 8 months. These may include seasonal fruit mashed to make it easy to digest, and home-made soft foods prepared from rice, wheat, ragi, rava, khichdi, etc. Natural, fresh, home-cooked food is recommended while packaged baby products such as cereals and milk powder should be avoided.

For infants aged less than 9 months, breastfeed the baby before feeding other foods.

At the age of 1 year and above, the baby should be fed a home-cooked diet such as fruit, green, leafy vegetables, and preparations from wheat-flour (un-sieved) unpolished rice.

Remember, babies need more food than you might imagine, even as much as half an adult diet! Also, feed your baby small portions at regular intervals and never large meals.

13. How long should a baby suckle?
At the beginning of the feed, the milk (foremilk) usually appears blue and watery. It is rich in proteins, vitamins, lactose, minerals and is 80 per cent water.

Towards the end of the feed, the milk (hindmilk) is whiter because it is rich in fat. Babies need both foremilk and hindmilk. This is why they must be allowed to keep suckling from one side till they receive the hindmilk and leave the breast on their own. They should be offered the other breast only after this. Babies allowed such freedom are usually satisfied with feeding from one breast.

14. How often should a baby be breastfed?
A baby should be breastfed as often as he / she demands. This doesn’t mean the baby must be fed every time he / she cries. Every time a bay cries, it doesn’t mean he / she is hungry. Learn to tell the difference and feed your baby only when he / she is hungry.

15. How long should each feed last?
There are ‘fast feeders’ and ‘slow feeders’. So a feed may range from 5 minutes to 20 minutes. Slow feeders, who take longer to suckle, receive the same amount of milk as fast feeders. Thumb rule: allow the baby to feed till he / she stops. This ensures that the baby gets sufficient energy-rich hindmilk.

16. How long should a baby be breastfed?
Breastfeeding should continue well into the second year. Breast milk is a rich source of nutrients and strengthens the developing immune system. When a baby learns to crawl, walk and play with other children, the chances of falling ill increase. Breast milk, which is highly nutritious and contains antibodies, keeps a child healthy and helps him / her easily recover from simple illnesses.

FOR MOTHER…
1. How do you prevent and treat engorgement of the breast and breast abscesses?
Some mothers suffer from a ‘congested breast’ three to four days after delivery. The simple and most natural way to relieve an engorged breast is to express the milk from it. The milk is highly nutritious and may be drunk by the mother if she so wishes. Also, feeding the baby on demand helps relieve congestion.

If the breast gets infected, breastfeeding can continue. If the mother chooses not to, she may express her milk, which may be fed to the baby in a cup.

2. Under what conditions should a mother not breastfeed?
Breastfeeding may be stopped only if the mother is so ill that she needs to be hospitalised; if she has cancer; is undergoing radiation treatment or receiving drugs to treat cancer.

Breastfeeding may continue even if the mother has infections such as infective hepatitis, typhoid, cholera, tuberculosis or leprosy. The byproducts of certain drugs taken by the mother are excreted through breast milk but they usually do not harm the baby.

Also, menstruation and pregnancy (half-way) are no reason to stop breastfeeding. If the mother is receiving sufficient nutrition, she may breastfeed throughout her pregnancy.

3. What happens if mother and baby are separated? For instance, if the mother needs to undergo surgery?
Under such circumstances, the mother should keep expressing her milk so that the baby is not deprived of mother’s milk. This also prevents engorgement of the breasts.

4. Why are mothers advised against artificial feeding and bottle feeding?
In developing countries such as India, a bottle-fed baby is 25 times more likely to die of diarrhea than a baby fed exclusively on breast milk in the first 4-6 months. Artificially-fed babies are more prone to malnutrition, severe respiratory infections, meningitis, polio, eczema, cancer, caries, coronary artery disease, insulin-dependent diabetes, etc. Alternatively, breast-fed babies bond better with their mothers; they are also more intelligent.

Also, powdered milk is likely to cause more problems than liquid milk. If mixed incorrectly, it could cause malnutrition or obesity, hypernatraemia with convulsions due to concentrated feeds.

Caution : Do not let manufacturers tempt you to buy stocks of powdered milk at subsidised or reduced rates. This is barred by a 1986 Resolution passed by the World Health Organisation. India has voted for this resolution.

5. Do mothers benefit from breastfeeding?
Mothers who breastfeed experience contraction of the womb, which helps them quickly regain their natural figure. She is less likely to develop cancer of the breast and ovary. Breastfeeding also delays conception but this is not foolproof.

6. Do working women have no choice but to bottle-feed their babies?
According to government regulations, women are entitled to 3 months’ maternity leave. Hence, breastfeeding during this time is possible. After that, mothers can express their milk, which may be fed to the baby with a cup. Expressed milk can be stored for at least 8 hours at room temperature without spoiling.

When the baby is 8 months old, he / she can drink expressed milk and start eating mashed foods as explained in the earlier (‘For Baby…’ section).

DOS AND DON’TS
1. Colostrum for the first 3 days and breast milk for the first 4-6 months is all that a baby needs
2. A baby who only breastfeeds (no water at all) and urinates 6 times or more in 24 hours is getting enough breast milk
3. Frequent watery motions in an exclusively breastfed child who is active and passes urine adequately is normal
4. A baby must be allowed to keep suckling from one side till he / she receives the hindmilk and leaves the breast on his / her own
5. Newborns must be encouraged to suckle within an hour after delivery
6. More suckling means more breast milk. Allow the baby to feed as often and as long as he / she wants.
7. Demand feeding prevents breast engorgement and infection
8. Artificial feeding and bottle-feeding can lead to serious illness and death
9. Even one bottle-feed could mean the end of successful breastfeeding
10. A child does not need a bottle at any age

THUMB RULES OF BREASTFEEDING
1. Breast milk alone is the best possible food and drink for a baby in the first 4-6 months. No water or glucose is needed for babies even in hot and dry climates
2. Infants need other foods other than breast milk after they are 4-6 months old
3. Babies should start breastfeeding 1 hour after birth. A newborn must get colostrum – the thick, yellowish breast milk produced in the first few days after birth.
4. Frequent suckling at the breast produces enough breast milk. Mothers should engage in ‘intelligent’ demand feeding.
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