Breastfeeding and Complementary feeding

Introduction
Breast milk is an ideal food for neonates. It contains all the nutrients for the normal growth
and development of a baby from the time of birth to the first six months of life. Initiation of
breastfeeding -as early as possible after the birth of the baby. Breast feeding should be done
as and when the baby requires it. Exclusive breastfeeding should be continued for six months.
This means that only breast milk is given to the baby. No water or supplement is needed to be
given at this time. If medicines are prescribed by the doctor, they can be given, but
breastfeeding should continue as is.

Learning Objectives:
• Identify the importance of breastfeeding, good attachment
• Recognize the general complaints during breastfeeding and complementary feeding
• Apply this knowledge in real-life scenarios and suggest solutions
• Counsel mothers regarding the correct practice of breastfeeding and complementary
feeding

Positioning of the mother

• The mother can assume any position that is comfortable to her and the baby.
• She can sit or lie down.
• Her back should be well supported and she should not be leaning on her baby

Positioning of the baby

• Make sure that baby is wrapped properly in a cloth
• Baby's whole body is supported not just neck or shoulders
• Baby's head and body are in one line without any twist in the neck
 • Baby's body turned towards the mother (abdomens of the baby and the mother
touching each other)
• Baby's nose is at the level of the nipple.

Attachment
Signs of good attachment-
• Baby’s mouth is wide open
• Most of the nipple and areola are in the mouth
• Only the upper part of areola is visible.
• Baby’s chin touches the breast
• The baby’s lower lip is everted

Effective suckling-
• Baby suckles slowly and pauses in between to swallow
• Baby’s cheek are full and not hollow or retracted during suckling

Benefits of breastfeeding
To the baby To the mother To the society
• Nutritional • Helps in the • It is economical. It
 superiority involution of uterus doesn’t cost the
• Contains • Reduced the chances family anything extra
carbohydrates, fats, of postpartum • Lowers the
proteins, vitamins haemorrhage and healthcare cost to the
and minerals that are anemia society by reducing
easily digested and • Reduces the risk of illness among
help in the growth breast and ovarian children
and development of cancer
the baby • It is convenient,
• Water and electrolyte needs no preparation
• Immunological and is readily
superiority available at the right
• Contain temperature
immunoglobulin, • Helps in delaying
lactoferrin, another pregnancy
lysozyme, bifidus due to lactational
factor and interferon amenorrhea
among others
• Protection against
illnesses
• Enhances the
emotional bond
between the mother
and baby

Common problems during breast feeding

1. Breast engorgement
 If feeding is delayed or infrequent, or the baby is not well positioned at the
breast, the milk accumulates in the alveoli. As milk production increases, the
amount of milk in the breast exceeds the capacity of the alveoli to store it
comfortably. This leads to engorgement of breast.
 Symptoms include pain, the local rise of temperature, and swollen, hard
breasts.
 Breast engorgement can be prevented by early and frequent feeds and correct
attachment of the baby to the breast
 Treatment consists of local warm water packs, breast massage and analgesics
to relieve the pain. Milk should be gently expressed to soften the breast.

2. Not having enough milk

 First make sure that the perception of "not enough milk" is correct.
 If baby is satisfied and sleeping for 2-3 hr after breastfeeding, passing urine at
least 6-8 times in 24 hr and gaining weight, the mother is producing enough
milk.
 Some reasons for not having enough milk may be: incorrect method of
breastfeeding, supplementary or bottle feeding, no night breastfeeding,
 engorgement of breast, any illness, painful condition, maternal stress or
insufficient sleep

3. Inverted nipple
 Inverted or retracted nipples make latching difficult.
 As the baby is not able to take nipple and areola in the mouth properly,
sucking on the nipples makes them sore and excoriated
 The nipple is manually everted, stretched and rolled out several times a day.

4. Sore nipple
 Nipples become sore when baby suckles on the nipple rather than areola
because of incorrect attachment
 As the baby is unable to express milk, he sucks vigorously in frustration and
bites the nipple causing soreness.
 Treatment consists of correct positioning and latching of the baby to the
breast.
 There is no need to apply any cream or ointment to the sore nipples.

5. Breast abscess
 If a congested engorged breast, cracked nipple, blocked duct or mastitis are
not treated in the early stages, breast abscess formation can occur.
 The mother has high grade fever and a raised blood count.
 She must be treated with analgesics and antibiotics. The abscess may require
incision and drainage.
 Breastfeeding must be continued.

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. This transition is referred to
as complementary feeding.

Attributes of food for complementary feeding

• Easy availability of clean and safe ingredients for foods.
• Simple and less time-consuming method to prepare/cook the foods.
• Affordability by the family.
• Prefer the regular family food that is locally available and culturally acceptable
• Easily digestible
• Start feeding with small amounts and gradually increase the quantity with the
increasing age of the child
Precautions to be taken while preparing the food
• Follow proper hand washing with soap before preparing and eating the food.
• The foods shall be stored safely and served fresh after preparation.
• Use clean utensils for preparing and serving the food.
• Spoon, cups, and bowls used for feeding the children shall be clean.
• Avoid using feeding bottle

Type and the consistency of food for growing child

References
1. Park’s Textbook Of Preventive & Social Medicine, 26th Edition (Page 612, 615, 621)
2. O.P. Ghai Essential Pediatrics, 9th Edition (Page 145-149)
3. IAP textbook of pediatrics, 5th Edition (Page 118- 126)
4. For the video on breastfeeding: Stanford Center for Health Education
[StanfordCenterforHealthEducation]. (2017, March 15). Breastfeeding (Hindi).
Youtube. https://www.youtube.com/watch?v=vOZMYnjyX2I
5. For the video on good attachment: https://www.youtube.com/watch?
v=HnQwDqkLYo0