Breastfeeding

Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief
among these is protection against gastrointestinal infections which is observed not only
in developing but also industrialized countries. Early initiation of breastfeeding, within 1
hour of birth, protects the newborn from acquiring infections and reduces newborn
mortality. The risk of mortality due to diarrhoea and other infections can increase in
infants who are either partially breastfed or not breastfed at all.

Breast-milk is also an important source of energy and nutrients in children aged 6–23
months. It can provide half or more of a child’s energy needs between the ages of 6 and
12 months, and one third of energy needs between 12 and 24 months. Breast milk is
also a critical source of energy and nutrients during illness, and reduces mortality
among children who are malnourished.

Breast milk composition: What’s in your breast milk?

It’s full of nutrients that feed and protect your baby, but did you
know breast milk composition varies over time? Find out what’s
in breast milk and how it changes to meet your baby’s needs

As your baby’s first food, you might expect your breast milk ingredients to
include basic essential nutrients, such as carbohydrates, proteins and fats, as
well as water to keep her hydrated, which it does.1 But breast milk is no
ordinary food – it has more value than nutrition alone.

What’s breast milk made of?

Here are some of the other constituents of human milk present at every feed,
many of which can’t be replicated:

 Millions of live cells. These include immune-boosting white blood cells,

as well as stem cells, which may help organs develop and heal.2
 More than 1,000 proteins3 that help your baby grow and develop,
activate her immune system, and develop and protect neurons in her
brain.

 All that breast milk protein is made up of amino acids. There are more
than 20 of these compounds in your milk. Some of them, called
nucleotides, increase at night and scientists think they may
induce sleep.4,5

 Over 200 complex sugars called oligosaccharides6 that act as

prebiotics, feeding ‘good bacteria’ in your baby’s gut. They also prevent
infections entering her bloodstream and lower her risk of brain
inflammation.

 More than 40 enzymes.7 Enzymes are catalysts that speed up chemical

reactions in the body. The ones in your milk have jobs such as aiding
your baby’s digestion and immune system, as well as helping her
absorb iron.

 Growth factors that support healthy development.1 These affect many

parts of your baby’s body, including her intestines, blood vessels,
nervous system, and her glands, which secrete hormones.

 On the subject of hormones, your breast milk contains lots of them!

7
These clever chemicals send messages between tissues and organs
to ensure they work properly. Some helpregulate your baby’s appetite
and sleep patterns, and even aid the bond between you.

 Vitamins and minerals – nutrients that support healthy growth and

organ function, as well as help build your baby’s teeth and bones.1

 Antibodies, also known as immunoglobulins. There are five basic forms

of antibodies and all of them can be found in your milk.8 They protect
your baby against illnesses and infections by neutralising bacteria and
viruses.

 You may have heard of long-chain fatty acids because they play a

pivotal part in building your baby’s nervous system, as well as aid
 healthy brain and eye development.9 And, you’ve guessed it, there are
several of these in your milk too!

 1,400 microRNAs, which are thought to regulate gene expression, as

well as help prevent or halt disease development, support your baby’s
immune system, and play a role in remodelling the breast.10

While this is a long list, it’s only some of the ingredients in your breast milk –
and scientists are still discovering more. Remarkably, the levels of these
ingredients can fluctuate over time, depending on your baby’s age and
needs.

Let’s start at the beginning…

The first few days: Colostrum

The early milk your breasts produce after your baby’s birth is
called colostrum. This thick, sticky breast milk is often called ‘liquid gold’, not
just because of its yellow or orangey colour, but because it’s so important for
nourishing and protecting your vulnerable newborn.

At first you’ll produce very small amounts – just 40 to 50 ml (1.4 to 1.8 fl oz)
over 24 hours11 – but as your baby’s stomach is only the size of a marble,
that’s all she needs. Colostrum is also very easy to digest. And what it lacks
in quantity it makes up for in quality.

The composition of colostrum

Colostrum has the same ingredients that your later milk will have – it’s just
that the amounts of these ingredients are different, as it’s tailored to your
newborn’s needs.

For example, colostrum is sometimes referred to as a natural vaccination

because its levels of antibodies and white blood cells are so high. Your first
milk needs to contain these so it can protect your baby from infections and
diseases after she leaves the safety of your womb.
Colostrum’s protective qualities are also important for your baby’s digestive
system. Babies are born with a permeable gut lining, which colostrum coats
and seals.12,13 This is particularly important if your baby is premature, as she’ll
be more at risk from the dangerous gut condition necrotising
enterocolitis (NEC).13

It’s also rich in minerals and vitamins, with higher concentrations of vitamins
A, E and K than mature breast milk. The percentage of protein in colostrum is
higher too.1 Colostrum also acts like a laxative that helps your baby pass her
first poo, meconium.14

The next couple of weeks: Transitional milk

During the first week of your baby’s life, around two to four days after
delivery, your breast milk changes in quantity. You may feel your breasts
become fuller and firmer – a change known as your milk ‘coming in’. On the
third day, your baby will consume 300 to 400 ml (10.5 to 14 fl oz) of breast
milk per 24 hours, and by the fifth day this increases to 500 to 800 ml (18 to
28 fl oz), so it’s not surprising your breasts may feel bigger!11

From day five to 14, your milk is called transitional milk.15 As the name
suggests, it’s changing from colostrum to mature milk. It becomes creamier in
colour and texture, and also higher in fat, calories and lactose (a natural
sugar), making it the ideal food for your rapidly growing newborn.

But rest assured it’s still full of protective antibodies, live cells, ‘good’ bacteria
and other bioactive ingredients to help keep her healthy.15

Four weeks onwards: Mature milk

By the time your baby is four weeks old, your breast milk will be fully mature.
It’s rich in protein, sugar, vitamins and minerals, plus numerous bioactive
components – such as hormones, growth factors, enzymes and live cells – to
support your baby’s healthy growth and development.7

From four weeks, the nutritional content and levels of ingredients in mature
milk generally remain fairly consistent. But the composition of your breast
milk can still change from day to day and feed to feed.
For example, if you or your baby are ill, your body will make antibodies to
fight that particular illness, which become part of your milk. And, remarkably,
as your baby begins exploring the world and putting toys in her mouth, the
level of protective bacteria-fighting enzymes in your milk rises.16 This variation
in breast milk composition shows how it adapts to your baby’s changing
needs.

What are foremilk and hindmilk?

You may notice your milk seems thicker and creamier towards the end of a
feed. This is because, as the feed progresses, the fat composition gradually
increases due to the mechanics of milk moving through the breast. It’s often
referred to as hindmilk, while the first more ‘watery’ milk is known as foremilk.
These two names might lead you to think there’s a switch where foremilk
becomes hindmilk, but there isn’t. The change is a gradual process.15 Both
are essential parts of a completed feed, and rich in vitamins, minerals, protein
and sugars.

Your milk’s fat content relates to how drained your breast is. Your breasts will
be fuller at the start of some feeds (milk lower in fat) and more drained at the
start of other feeds (milk higher in fat). So don’t worry too much about
foremilk and hindmilk – over 24 hours your baby will end up consuming a
similar amount of fat in total each day.17

Breast milk composition after six months

You may be wondering what happens to your milk if you continue

breastfeeding long-term. Can your body really keep producing such high-
quality mature milk for months and months, or even years? The answer is,
don’t underestimate your breasts!

While it’s true you’ll need to start introducing solids at six months to bolster
your baby’s stores of certain nutrients, such as iron,18 your milk will still make
up a large part of her diet.
For example, when your baby is seven months old she will still be getting
93% of her calories from breast milk. Even between 11 and 16 months,
around half of her daily calorie intake will be from milk.19

So relax in the knowledge that you can both continue to enjoy the benefits of
breastfeeding for many months to come.

Children and adolescents who were breastfed as babies are less likely to be overweight
or obese. Additionally, they perform better on intelligence tests and have higher school
attendance. Breastfeeding is associated with higher income in adult life. Improving child
development and reducing health costs results in economic gains for individual families
as well as at the national level.(1)

Longer durations of breastfeeding also contribute to the health and well-being of

mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–
exclusive breastfeeding of babies under 6 months has a hormonal effect which often
induces a lack of menstruation. This is a natural (though not fail-safe) method of birth
control known as the Lactation Amenorrhoea Method.

Mothers and families need to be supported for their children to be optimally breastfed.
Actions that help protect, promote and support breastfeeding include:

 adoption of policies such as the International Labour Organization’s "Maternity

Protection Convention 183" and "Recommendation No. 191", which
complements "Convention No. 183" by suggesting a longer duration of leave and higher
benefits;
 adoption of the "International Code of Marketing of Breast-milk Substitutes" and
subsequent relevant World Health Assembly resolutions;
 implementation of the "Ten Steps to Successful Breastfeeding" specified in the Baby-
Friendly Hospital Initiative, including:
o skin-to-skin contact between mother and baby immediately after birth and
initiation of breastfeeding within the first hour of life;
o breastfeeding on demand (that is, as often as the child wants, day and night);
o rooming-in (allowing mothers and infants to remain together 24 hours a day);
o not giving babies additional food or drink, even water, unless medically
necessary;
 provision of supportive health services with infant and young child feeding counselling
during all contacts with caregivers and young children, such as during antenatal and
postnatal care, well-child and sick child visits, and immunization; and
 community support, including mother support groups and community-based health
promotion and education activities.
Breastfeeding practices are highly responsive to supportive interventions, and the
prevalence of exclusive and continued breastfeeding can be improved over the course
of a few years.

Complementary feeding

Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed
what is provided by breast milk, and complementary foods are necessary to meet those
needs. An infant of this age is also developmentally ready for other foods. If
complementary foods are not introduced around the age of 6 months, or if they are
given inappropriately, an infant’s growth may falter. Guiding principles for appropriate
complementary feeding are:

 continue frequent, on-demand breastfeeding until 2 years of age or beyond;

 practise responsive feeding (for example, feed infants directly and assist older children.
Feed slowly and patiently, encourage them to eat but do not force them, talk to the child
and maintain eye contact);
 practise good hygiene and proper food handling;
 start at 6 months with small amounts of food and increase gradually as the child gets
older;
 gradually increase food consistency and variety;
 increase the number of times that the child is fed: 2–3 meals per day for infants 6–8
months of age and 3–4 meals per day for infants 9–23 months of age, with 1–2
additional snacks as required;
 use fortified complementary foods or vitamin-mineral supplements as needed; and
 during illness, increase fluid intake including more breastfeeding, and offer soft, favourite
foods.