Overview of Breast Feeding: A review

P. Snekapriya*

Dietician, Kauvery hospital, Trichy, India.

*Correspondence: dietary.kcn@kauveryhospitals.com

Abstract

Nutrient needs of infants reflect rates of growth, energy expended in activity, basal metabolic needs and the interaction of the nutrients consumed. Full – term infants who are breast -feed to satiety or who are feed a standard infant formula generally adjust their intake to meet their energy needs when care given are sensitive to the infants’ hunger and satiety.

Human milk or infant formula provides the major portion of protein during the first year of life. The amount of protein in human milk is adequate for the first 6 month of life.

Breast-Feeding

Concept of infant and young child feeding

  1. Every infant and child has the right to good nutrition according to the convention on the rights of the child
  2. Under nutrition is associated with 45% of child deaths. Globally in 2020,149 million children under 4 were estimated to be stunted (too short for age), 45 million were estimated to be washed (too thin for height) and 38.9 million were overweight or obese
  3. About 44% of infant 0-6-month old are exclusively breastfeed.
  4. Over 820,000 children’s lives could be saved every year among children under 5 years, if all children’s 0-23 months were optimally breastfed.
  5. Breastfeeding improves IQ, school attendance, and is associated with higher income in adult life.

Who and UNICEF Recommend

  1. Early initiation of breastfeeding within 1 hour of birth.
  2. Exclusive breastfeeding for the first 6 month of life.
  3. Introduction of nutritionally adequate and safe complementary foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.
  4. Recommendation have been refined to also address the needs for infant born to HIV – infected mothers.
  5. Antiretroviral drugs now allow their children to exclusively breastfeed until they are 6 months old and continue breastfeeding until at least 12 month 0f age with a significantly reduce risk of HIV transmission.

Definition of breastfeeding

The world nutrition is desired from nutricus which means to suckle at the breast’. Breast milk is the natural food for the infant. Successful breast feeding is an important child rearing skill to be learn and practiced.

The infant should be put to breast within half an hour after normal delivery normal delivery and within four hours after caesarian section. Prelacteal foods like honey, distilled water or glucose should not be given, these foods will satisfy the thirst and will reduce the vigour to suck and may lead to sedated or on IV fluids. Sucki9ng reflex is most active at birth.

Types of breast milk

Colostrum

During the first two or three days after delivery, thick and yellowish fluid is secreted from the mammary gland. this differs from the regular milk and is called colostrum.it is secreted in small quantity of about 10 – 40 ml. It is rich in protein. the total fat content of colostrum is less than mature milk. Concentration of arachidonic acid and docosa hexaenoic acid (DHA) as per cent of total fatty is aids is higher in colostrum than mature milk.

It has more amount of vitamin A and K. The concentration of lactose is also less. The levels of niacin, pantothenic acid, biotin and riboflavin are also low. Vitamin C is secreted at about the same level as in mature milk. Zinc content of colostrum is 20 mg/whereas mature milk has 2.6 mg/l.

Colostrum is the first immunization to the infant. It contains an interferon like substance which possesses strong antiviral activity. Colostrum contains B 12 binding protein which renders B12 unavailable for the growth of E. coli and other bacteria. It also contains antibodies against viral diseases such as small pox, polio, measles and influenza. Enzymes like lysozyme, peroxidase and xanthine oxidase that promote cell maturation are found to be more in colostrum. Colostrum contains large quantities of protective substances and enhances the development and maturation of the baby’s gastrointestinal tract. Colostrum helps a baby pass his or her first stool.

Transition milk

During the next two weeks, the milk increases in quantity and changes in appearance and composition. This is called transition milk. The immunoglobulin and protein content decreases while the aft and sugar content increases. Exclusive breast feeding of colostrum and transition milk minimizes infection related to neonatal deaths.

The composition of milk changes even during the length of a single feed to exactly suit the need of a particular baby.

Fore milk

The milk that comes at the start of a feed is called foremilk. Fore milk which is watery has a low level of fat and is high in lactose sugar, protein, vitamins, minerals and water. It satisfies the baby’s thirst.

Hind milk

Hind milk which comes later in a feed, is richer in fat. It satisfies the baby hunger and supplies more energy than fore milk. Babies who are fed fore and hind milk sleep well and grow healthy.

There are no tailor need schedules for breastfeeding, as milk production, sucking habits and stomach capacity vary from infant to infant. A few days after the initiation of breastfeeding, the length of each feed and the interval between two feeds will automatically get regularized. Exclusive breast feeding for the first six months gives a baby best start to life. No water or supplementary food is given during this period.

Composition of colostrum

Nutrient

Amount
Energy kcal 58
Fat (g) 2.9
Calcium (mg) 31
Phosphorus (mg) 14
Iron (mg) 0.09
Protein (g) 2.7
Lactose (g) 5.3
Carotene (I.U) 186
Vitamin A.(I.U) 296

*Breast milk contains about 88.5% of water and 11.5% of solids

Solids include

  1. Nutrient – Lactose, casein, lacto albumin, lacto globulin, cholesterol and essential fatty acids
  2. Mineral – Sodium, calcium, potassium, magnesium, chloride, phosphorous, negligible quantity of iron and copper
  3. Vitamins – A, B, C, D, E, K
  4. Immunoglobulin – Ig A, Ig G and Ig M
  5. Antibacterial agents – lysosomes and lactoferrin
  6. Cells – Neutrophils and other leukocyte, macrophages and stem cell
  7. Other – digestive enzymes hormones, transforming growth factor -B, interleukin -10 and insulin – like growth factor.

Benefits of breastfeeding

For infants

Decreases incidence and severity of infectious diseases such as

  1. Diarrhea
  2. Infant botulism
  3. Respiratory tract infection
  4. UTI
  5. Bacterial meningitis
  6. Necrotizing enterocolitis

Decrease rates of other disease

  1. Asthma
  2. Crohn’s disease
  3. Celiac disease
  4. Food allergies
  5. Hodgkin disease
  6. Leukemia
  7. Lymphoma
  8. Obesity and overweight
  9. Type 1 and type 2 diabetic mellitus
  10. Sudden infant death syndrome
  11. Hypercholesterolemia

For Mother

  1. Decrease menstrual blood loss
  2. Decrease postpartum bleeding
  3. Decrease risk of hormones (breast and ovarian cancer)
  4. Increase child spacing

For society

  1. Decrease health care costs
  2. Prevent excess cost wages resulting from employee’s absentees for sick children

Disadvantages of animal milk

  1. It causes irritation of GI tract and anemia.
  2. Excess proteins and fats in animal milk are difficult to digest and absorb by the infants
  3. High content of casein is harder to digest resulting in GI bleeding and anemia
  4. High concentration of sodium and potassium in animal milk causes over straining of immature kidney in infants.
  5. Low iron content in animal milk develops iron deficiency anemia.
  6. It has low content of vitamins and essential fatty acids.

Storage of human milk for healthy full term infants

Location

Temperature

Maximum time

Comment
Outside refrigerator Room temperature (60deg F -85deg F) 3-4 hr (optimal)

6-8 hr (maximum)

 Containers should be covered.

Discard leftover milk within 1-2 hr after feeding.
Refrigerator 39 degF 72 hr (optimal)

5-8 days maximum

 Keep milk in near of refrigerator for maximum cooling
Freezer 0degF 6 month (optimal)

12month (maximum)

 Store in back of freezer for constant temperature
Small cooler with blue ice pack 59degF 2 hr Ice pack should be constant with containers. Keep cooler closed.

Open only when needed.

Room temperature (60deg F -85deg F)

Refrigerator (39degF)

Freezer
Thawed breastmilk 1 – 2 hr (optimal)

3- 4 hr (maximum)

 24 hr Do not refreeze

Human breast milk storage for hospitalized infants

Storage method

Recommended storage time
Freezer (home unit combined with refrigerator ) 3 month
Freezer (-20 ℃,-4degF) 6-12 month
Freezer (-70 ℃,-94degF) ≥12 month
Refrigerator(4℃,40degF),fresh milk 48-96 hr
Refrigerator(4℃,40degF),thawed milk 24 hr
Refrigerator(4℃,40degF),fortified milk 24 hr
Refrigerator(4℃,40degF),thawed pasteurized donor milk 48 hr
Cooler with ice pack(15℃,59degF),fresh milk 24 hr
Room temperature(25℃,77degF) 4 hr

 

Reference

 

  1. Krause’s – food and the nutrition care process – L.Kathieen Mahan, Janice L, Raymond – 14th edition
  2. Dietetics – B,Srilakshmi – New age international publishers – 7th edition
  3. Applied nutrition – dietetics and biochemistry for basic Bsc nursing – I clement – Jaypee brothers medical publishers – 2nd edition
  4. Medical physiology – K. Sembulingam – Jaypee brothers medical publishers – 8th edition.
Snekapriya

P. Snekapriya

Dietician

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