After birth, the best food for a new-born is mother’s milk. It is known that a large majority of women could successfully breast feed their babies, if they were given proper guidance both before and after child birth. Failure to breast feed the baby is nearly always due to some mistake committed because of lack of proper knowledge of nature’s laws (physiology) of lactation.
Superiority of breast milk over cow’s milk. Breast milk is considered superior to cow’s milk, whether fresh or powdered, for the following reasons:
- Proteins—.in breast milk are easily digested as they form a very fine flocculent curd in the stomach. The curd of the cow’s milk is thick and hard to digest for the young stomach due to large proportion of casinogen.
- Breast milk contains twice as much iron as in the cow’s milk. This iron is essential for the newborn and meets its needs upto 3 months. Anaemia is commonly seen in babies fed on cow’s milk even before three months.
- Calcium of breast milk is utilized better as it is present in a more assimilable form.
- Vitamin A is present in larger quantities in colostrum_ Mother’s milk contains more vitamin A than that in cow’s milk.
- Vitamin C content of breast milk is related to vitamin C content of mother’s diet, but in general it is higher. Cow’s milk looses its vitamin C content due to boiling, dilution and exposure to air.
Some other advantages of breast milk are : (1) Breast milk is free of contamination. (2) It 1.8 always and everywhere available at a temperature suitable for baby’s digestion. (3) It’s preparation does riot need the elaborate and time-consuming process of sterilization of utensils, warming of formula, and cleaning and washing of utensils after feeds. It is automatically processed. (4) Breast feeding helps in proper involution of the uterus and its appendages after child birth. (5) Breast feeding gives the child and its mother an opporunity to be close to each other. It gives mother a sense of accomplishment and confidence and to child a sense of security. (6) Breast milk provides certain degree of protection from infection by transfer of antibodies. (7) Though small, breast feeding has a role in regulating fertility of the mother, specially if it is continued for a long time.
The reflex mechanism of lactation. When a healthy newborn child is put to breast for the first time it reflexively draws the nipple and part of the areola in its mouth and starts sucking. Sensations from the nipple travel via two routes to the pituitary gland. Through the first route, they reach the anterior pituitary and stimulate production of ‘prolactin’. This hormone activates the breast tissue to produce milk. Sensations from the second route go to the posterior pituitary which as a result produces ‘oX–Ytociri’. This hormone causes contration of the muscles around the milk producing ducts and helps in pushing the milk towards the sinuses in the area or region. Pressure of baby’s jaws on the areola empties milk into the baby’s mouth.
Factors that regulate initiation and maintenance of breast feeding.
The initiation and maintenance of breast feeding follows the principles of demand and supply as in general economics. All other factors being constant, the flow of milk can be sustained by complete and repeated emptying of breast at frequent intervals. The regulating factors can be listed in an easy to remember way as the ‘Five (1) Force of sucking by the baby; (2) Frequency of sucking by the baby and time of first feed; (3) Foods and fluids taken by the mother; (4) Feelings other mother; (5) Family support for breast feeding mother.
Derangement of breast feeding. Lactation is hampered: (1) If there is a weak sucking effort by the child due to prematurity, birth injury, cleft- palate, hare-lip or heavy sedation; (2) If the child’s appetite has been reduced by prelacteal feeds of honey, sugar or other milk; (3) If the child has received a bottle with a soft nipple for its first few feeds: (5) If the mother is worried or is unwilling to feed the baby due to painful cracked nipple or any other reason; (6) If the mother fails to put child to breast frequently as in case of inexperienced teenagers, sick mothers or mothers who have a painful episiotomy or Caesarean section wound; (7) If the mother has to spend long hours away from her child, e.g., a working woman away from home for several hours; (8) If the mother is not taking the right type of food or enough fluids to meet the increased nutrient demands during lactation; (9) If the family members specially the husband, mother- in-law or other adult members, are not aware of the mother’s special needs for rest, nutrition and privacy; (10) If the parents are not conscious of their new responsibilities of parenthood and instead attach priority to light and gala social life.
Artificial feeding. (a) Commercially prepared baby formulae are in common use although ideally these should not be recommended. Most of these are based on cow’s milk that has been treated so that the protein is somewhat more digestible. Most of the butter has, been replaced with vegetable oil; thus the formulae, contain a high level of polyunsaturated fatty acids than those in the human milk. All are fortified with vitamins, and most are fortified with iron. Most have a calorie content of 20 calories per ounce. (b) Cow’s milk is widely used for baby feeding. When used as baby feed, it needs to be diluted and sugar added to, it It has to be boiled, cooled and then given to the baby.
Scheduled or demand baby feeding. Adhering to strict schedules so often taught in the past is neither justified nor possible for the new-born or a small child. Most of the babies do not suck well in the first two or three da.vs. Also appetite of each child differs. It is better to advise mothers to wait with patience and allow the child to use its own free will and fix up a schedule for itself. An average healthy child soon settles down to a 3-4 hourly routine. Night,feeds may be necessary for first three or four months. As the baby grows, and fulfills its calorie needs during the day these may no longer be needed.
Approximate daily requirements of a full-term normal baby for milk are:
First day 60 ml/kg
Second day 60 ml/kg
Third day 90 ml/kg
Fourth day 120 ml/kg
Fifth day 150 ml/kg
Generally a normal healthy mother will be able to provide these quantities without adverse effects on her own health provided she is receiving a balanced diet.
A baby who is satisfied, happy, sleeps well for 3-4 hours at a stretch and is gaining on an average around 200-400 grams per week, can be considered as a well-fed baby.
Absolute or exclusive breast-fed baby. Under any circumstances, breast milk is the ideal food for the babay, and no other food is required until 4-5 months after birth. When a baby is given only breast milk. and not even a drop of water, upto 5 months of age it is called an absolute or exclusive breast feeding.
Milk injury. If a baby is fed only with milk over 4 long period of time. say 2 years without giving any supplementary food, the baby becomes flabby and oedematous due to deficiency of protein, and anaemic due to iron deficiency. This is called milk injury.
Weaning is a gradual process of withdrawing a baby from breast feeding
It is starting around the age of 5 months and adding supplementary foods rich in protein and other nutrients, such as cow’s milk, fruit juice, soft cooked rice, cereals and pulses (smashed khichuri), shuji, soup, smashed potato, and vegetable. Weaning period is crucial in child development, and if adequate importance is not given the child may’ suffer from malnutrition and infection.
Absolute breast feeding for the first 5-6 months followed by introduction of weaning foods on completion of four months is a rational regimen. Along with other foods, breast feeding, even if in small quantites, should continue up to two years by which time the child should be ready to share family food.