Breast-feeding, the best source of food for babies

By Donya Betancourt

SANUR, Bali (JP): As we know , breast-feeding is the perfect source of food for babies, it is full of nutrition and immunities and it is the cheapest milk in the world.

But a few mothers have problems when breast-feeding. Why is breast-feeding so simple and easy for one mother and, at the same time, it is so hard and difficult for the other, especially a working mother? What is the problem?

Feeding is something babies have to learn. When a newborn baby is hungry or thirsty, he feels uncomfortable so he cries but at this early stage he is not crying to be fed. Not until after suckling will he learn that suckling brings food and comfort.

Some babies are already sucking their fingers in the womb and when they are born they suck anything that comes their way making it easier for their parents. Other babies are quite different. They cry but when their mothers try nursing them they yell even more, possibly making the mom feel anxious. But don't worry, once they have suckled a few times, the feeding lesson is learned.

Starting with breast-feeding keeps your options open while giving baby a host of benefits. If you find you don't enjoy it, or it doesn't suit you, you can always switch to bottle-feeding. But if you start with the bottle, you can't switch to breast milk because your breasts will not be producing milk.

The fact is, breast-feeding is not instinct. It is a learning process between mother and baby so the mother should learn as much as possible about it before the baby is born. The best person to learn from is someone who has successfully nursed a baby, also obstetricians, pediatricians, nurses and midwives can help.

Question: Can the mother guarantee success in breast-feeding?

Answer: Almost always if the mother follows a few steps, such as during pregnancy the mother eats optimal nutrition foods i.e. all five food groups: meat, dairy products, grains, fruit and vegetables; and increases intake by 300 Kcal a day more than before pregnancy and gains at least 10 kg.

Take care of your breasts by using a support bra during pregnancy because breast weight will increase by three to four times. If the mother has a blind nipple, she should get early advice. Do not massage the breasts in your third trimester because it may stimulate preterm labor.

After delivery. Tips are early suckling, proper suckling and frequent suckling with no water or formula supplements. Nursing should begin as early as possible. The best time is within an hour and not more than six hours after delivery.

Positioning the baby so it has a good latch on the areola is important for success. First, roll the baby's body in towards you while the baby's mouth should be wide open and then, move the baby onto the breast with his jaw well down the areola and its mouth full of breast and the nipple down right back in the baby's mouth.

The baby doesn't suck milk from the nipple but presses the milk sacs with his jaws and tongue. The more the baby suckles the more milk is produced so the baby should be fed frequently, at least every two hours and not on any strict schedule.

Why is breast milk so good?

Breast milk has optimal nutrition and provides the best immunity for babies.

As regards the nutrition aspect, in the first two to three days after giving birth you will produce creamy "colostrum", which has the right amount of water, sugar, protein, and minerals plus many important antibodies from you that protect the baby's health while he is building his own immune system. There is no artificial equivalent of colostrum. From three days to two weeks after that, you will produce "transitional milk" and then "mature milk", which is higher in energy, with carbohydrate and fat but less protein than colostrum.

Protein in breast milk has no "beta-lactoglobulin", which is found in cow's milk and causes allergies. Mother's milk carbohydrate is lactose, which is easy to digest and also has an effect on stool formation -- which is why a stool from a breast- feeding baby is softer than that from a bottle-feeding baby.

The fat in breast milk has essential fatty acids in the concentration that baby needs. If the mother eats right, the breast-fed baby will get all the vitamins that it needs without supplements. Minerals in breast milk are absorbed better than they are with cow's milk.

As for the immunity aspect, it is true that breast-fed babies have less gastrointestinal and respiratory infections than bottle-fed babies. You don't have to worry about the hygiene of breast milk because it comes right out from your own breast at the right temperature and level of sterility. Other than that it also has antibodies, antiviral factor, bidifidus growth factor (which inhibits yeast, bacteria, e.g. Eschericia coli,), white blood cells, and some other beneficial enzymes that inhibit bacteria and yeast.

Which nutrients are inadequate in breast milk?

Iron should be supplemented when solid foods are started. Vitamin D should be added when exposure to sunlight is reduced. It is also recommended for dark-skinned infants.

Are formula and water supplements necessary in breast-fed babies?

No!

How long can I feed my baby breast milk?

It is recommended to feed for at least one year with the introduction of supplementary food at four to six months. The amount of milk production differs at different times. In the first month the amount is 500-700 gm/day. It will reach a maximum of 700-1100 gm/day at 9 months and slowly decrease to 350-700 gm/day at 24 months. The carbohydrate content is quite similar over the whole period up to 2 years but protein and fat will decrease after 1 year. The important thing is to breast-feed your baby as long as possible and enjoy it, even 1 month is better than nothing.

Should breast-feeding be continued throughout most maternal illness?

Yes. The exceptions are where the mother is HIV positive, or has active untreated tuberculosis, herpes of the breast region or primary herpes. Most common illnesses such as colds, diarrhea, or breast skin infection (mastitis) can't pass through breast milk. If a breast abscess occurs, nursing can continue on the unaffected breast.

Which drugs should be avoided during breast-feeding?

Oral anticoagulants (coumadin) may produce a bleeding problem; tetracycline produces dental staining; thiouracil may inhibit the infant's thyroid function; and cimetidine which achieves higher levels in milk than in maternal serum, antineoplastic agents (chemotherapy), radioactive drugs, lithium, atropine, and ergot alkaloid.

Is it true that breast-feeding decreases the risk of childhood obesity?

There was a study done in Germany in 1999 and the results show a prevalence of obesity in children who have never been breast- fed at a rate of 4.5 percent as compared with 2.8 percent in breast-fed children.

The study also showed that the duration of breast-feeding effects the prevalence of obesity: 3.8 percent for two months of exclusive breast feeding, 2.3 percent for three to five months, 1.7 percent for six to 12 months, and 0.8 percent for more than 12 months.

In industrialized countries promoting prolonged breast-feeding may help decrease obesity in children. As obese children have a high risk of becoming obese adults, this will also decrease the risk of cardiovascular disease and other related diseases of obesity.

There are many common questions and problems which arise when breast-feeding. The next issue will discuss some problem cases. Wishing you every success in giving your baby the best start.

-- The writer, a pediatrician based in Sanur, Bali, welcomes questions, comments and concerns through drdonya@hotmail.com.