GIVE YOUR BABY THE BEST START IN LIFE
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GIVE YOUR BABY THE BEST
START IN LIFE - extracted text
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GIVE YOUR BABY THE BEST
START IN LIFE
1. Should I breastfeed my baby?
Yes, even,- mother should breastfeed her baby.
Breast milk is nature’s first gift to your babv. and
diere is no other substitute for it. For the first 1 to 6
months, breast milk is your baby's best and
complete food. Do not be misled by people who
suggest powdered milk ‘in case you think you do
not have enough milk’. It has been found that
almost all mothers are capable'of producing more
than enough milk for their baby’s need.
Nature in all its wisdom has ensured that you can
breastfeed successfully. All you need is the deter
mination to breastfeed, and faith in your own ability
to breastfeed successfully. Remember that breast
milk has many qualities which make it unique from
all other artificial milks available.
2. Will I be able to breastfeed successfully?
A common reason mothers give for stopping
breastfeeding is the fear that they do not have
enough milk, and so they introduce their babies to
artificial feeds in the first few days after birth.
Research shows that in practice, almost every
mother can breastfeed successfully. Rarely is there
any physical reason for being unable to feed the
baby naturally. The most important thing to
remember is that the mother must want to breast
feed, have confidence in her ability to breastfeed
successfully and must not lose hope.
Further, studies have shown that women who want
to breastfeed actually produce more milk than
those who don’t want to. or are indifferent about
breastfeeding their babies. Many women fail to
breastfeed successfully, even though they want to,
because they believe, incorrectly, that they do not
have enough milk for their baby’s need. The truth is
that almost ail mothers are capable of producing
more than enough milk for their baby’s need.
J. What is Colostrum? Is it important for my
baby?
For the first day or two, the milk that flows from the
breast is called colostrum. This first milk is extreme
ly nourishing for the newborn. What makes
colostrum even more special is the fact that this
first milk is full of antibodies produced by the
mother. These antibodies protect the newborn
against some diseases and infections at a time when
the baby is particularly vulnerable. Later milk also
contains these antibodies, but not as much as the
first milk. In addition, colostrum also has certain
properties that prevent allergic diseases like
asthama and eczema which are more common in
botdefed babies.
Traditionally, in many Indian homes, colostrum is
thrown away. Today we have learnt that in actual
fact, colostrum is extremely valuable to the new
born. Throwing away the colostrum deprives the
newborn of the best possible nourishment avail
able, aS well as the protection that it offers against
disease. Colostrum is very rich in proteins,
minerals and vitamins. In fact, colostrum is just
what the newborn needs soon after its birth.
No matter where a mother delivers her baby, at
home, hospital or the nursing home, she should
insist that the baby is kept with her in the same
room. This way she can ensure that her baby gets
the benefits of colostrum. Put the baby to the breast
soon after birth. The sooner the baby starts suckl
ing the breast, the sooner and better the milk will
flow. In addition, it will receive the benefits of
colostrum which flows only for the first day or two.
According to many doctors, colostrum has life-long
health preserving benefits.
4.
How often should a baby be breastfed in a
day?
Babies usually cry when they are hungry. Put your
baby to the breast each time it cries for a feed. This
demand feeding is a better way to feed your baby
instead of fixed schedules.
Babies could also cry for some other reasons, such
as if their nappy is wet or if die clothes are too tight.
Having checked that none of these is rhe source of
trouble, you should interpret the baby’s cry as its
demand to be breastfed.
Your baby is a special person, an individual unlike
other babies. It is not just a hungry stomach to be
filled at regular intervals. Once you accept that die
baby may' ask for a feed at different times, depend
ing on when it is-hungry, you are well on youi way
towards breastfeeding successfully. If y'ou worry'
each time it cries for a feed too soon, you are more
likely' to lose your milk. This happens because
worry' can interfere with the ‘let down’ of the milk
from your breasts.
While some babies setde down to a routine of
demand feeding after a few weeks, others don’t. So
do not compare your baby with other babies. Just
breastfeed your baby when it cries for a feed.
As the baby grows it may ask for fewer feeds and
may setde down to a regular demand routine, every
two, three or four hours. Sometimes your baby may
demand a feed more often than other dmes. This
could be for many reasons: the baby may be extra
hungry', growing rapidly, teething or is just upset. If
the baby needs extra feeds, your own milk supply
will adjust to its needs if you let the baby suckle as
much as it wants to and whenever it demands a
feed.
5.
How long should each breastfeed last?
Let your baby tell you how long it needs to suckle
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your breasts to get its fill. A hungry baby will cry’ lot
milk. The old rule of 10 minutes on each breast was
created because that was roughly the average time
that a baby takes to feed. But each baby is different.
So while some babies take less than 10 minutes to a
side to get their fill, others may take longer.
During the first few months, you may find that youi
baby wants a feed very' frequently. This is not un
usual and is the baby’s way of increasing your milk
supply to suit its growing needs. People may tell
you that a baby gets all the milk that it needs in the
first few minutes at each breast. But all babies are
not alike. A lot will depend on how vigorously the
baby suckles, the strength of your ‘let down’ reflex
and the time taken for the ‘let down’ or start of the
milk flow.
Remember that some babies enjoy suckling even if
they have had their fill. There is no reason to stop
this unless you have some other work to do, or if
you have sore nipples. This ‘comfort suckling’ is
considered by many' experts to be an important
factor in the child’s emotional development.
When y'our baby’ has had its fill on one breast, in
other words, when it loses interest in feeding,
change it to the other side. Let the baby' continue
feeding on the other breast as long as it wants to.
There are times when the baby will feel less hungry,
is sleepy or just tired and may not want to suckle
very' long. Don’t worry about this, and don’t force
the b.aby to feed. Just offer your breast after a little
while.
6.
How does a mother know if her baby is getting
enough milk?
It is true dtat when you breastfeed you cannot
actually see how much milk the baby drinks.
However, if your baby sleeps well, is healthy, active
and playful when awake and gains weight steadily
each mondt, then you can be sure that your baby is
getting enough milk for its nourishment and
growth.
7.
How can I increase the flow of milk in my
breasts?
The baby’s suckling is the best way to start and
increase the flow of milk in your breasts, and the
sooner the baby is put to the breast, the sooner and
better will be the flow of milk. Let the baby suckle as
frequently as possible because the more often a
baby suckles the breast, the better it stimulates the
breast to produce more milk. This is Nature’s secret
to start and increase the flow of milk to meet your
baby's growing needs.
Sometimes emotions like embarrassment, tension,
or fatigue can also interfere with the ‘let down’ of
the milk. A mother should therefore, relax and sit
comfortably when she feeds her baby.
"When the baby suckles, it stimulates two hormones
which are released into the mother’s bloodstream.
One of these hormones stimulates a strong flow of
blood through the breasts and activates the milk
making tissue. The other hormone causes the
breasts to push out or ‘let down’ the milk from the
breasts. This is generally felt as a ‘pins and needles’
sensation or a full feeling in the breasts. If the milk
doesn’t "let down’, vour baby will not get all the
milk that is available in the breasts. Fortunately
Nature has ensured that when the baby suckles
frequently, the ‘let down’ reflex works well.
8.
What should I eat to increase the flow of milk in
my breasts? Are there medicines to increase this
flow?
There are no special foods or medicines to improve
the quality and quantity of breast milk. To breast
feed successfully and to maintain her own health, a
nursing mother should eat slightly more of the food
she normally eats. There is no need to eat anything
special. An extra helping of rice or chapati, dal,
green leafs’ vegetables and fresh fruits will give the
nursing mother all the nourishment she needs to
produce enough milk for her baby and to maintain
her own health. Eggs, fish and meat are also good.
What is important is to eat slightly more of every
thing that she normally eats, rather dtan eating
anything special while nursing her baby.
Finally be assured, you can increase your milk
supply. Nature has made sure that when the baby
suckles the breast frequendy, the milk will flow
well. All you need is the confidence in your natural
ability to breastfeed successfully. Eat and rest well.
These early months can be a challenge, demanding
much patience and determination on your part. So
do relax and enjoy your baby. Remember that not
only is your baby receiving the best food available,
but also both your baby and you arc building a
happy and secure relationship during this period.
9.
How should a mother hold the baby while breast
feeding?
There is no ideal position to hold the baby while
breastfeeding. The main thing is to make yourself
comfortable because you will be in that position for
some time, and try’ to make the baby comfortable.
Pain and discomfort can reduce the ‘let down’ of
milk.
Support the baby’s weight with a pillow on your
lap. Another pillow under the arm supporting the
baby will also help.If you are sitting, it is easier to
feed if you sit upright and lean slightly forward.
Hold the baby with its chest and stomach against
you, so that it doesn’t have to turn its head around
and can feed comfortably. Some babies like to have
something to hold on to while feeding—give the
baby your finger to hold onto. At night, lie on your
side and breastfeed the baby.
Don’t push the baby’s mouth onto your nipple.
This could frighten the baby’. Instead, stroke the
side of its mouth with your nipple. If your breast is
very full, you may have to hold it back so that the
baby’s nose is not smothered. But don’t bother to
hold your nipple or breast once the baby starts
suckling. Expressing a little milk from a full breast
will soften it enough to enable the baby to hold on.
When breastfeeding, part of the areola (the dark
area around the nipple) should go into the baby’s
mouth as the milk reservoirs are under the areola
and need to be emptied by the baby’s suckling. If
only the nipple goes into the baby’s mouth, not
enough milk will flow out. The baby would have to
suckle extra hard and this could lead to sore
nipples. If you have an extra large areola, hold it
between the finger and thumb and squeeze them
together. This will make the areola flatter and easier
for the baby to take in its mouth.
You may notice that at times your baby stops
suckling and looks around. This happens because
the ‘let down” Causes the milk to be spurted in an
uneven flow. Several spurts of milk come out, and
then there is a short pause before the milk flows
again. Your baby is adapting to the flow of your
milkand its breathing pattern is also altered to fit in
with this drinking pattern.
10.
How should a mother stop a feed?
Some babies simply let the nipple, go when they
have had enough to drink, while others have to be
gently removed from the breast. Some babies also
like to suckle even after thev have had theif fdl. This
is called ‘comfort suckling.’ According to many
doctors, this should be encouraged because it helps
the emotional development of the baby.
Do not abruptly pull the baby’s mouth away from
vour breast while it is feeding. The force could
damage the nipple and the areola, apart from
frightening the babv. Instead, put the tip of your
little finger in the corner of the baby’s mouth and
gently draw the babv away.
11.
How can I tell when the baby has had enough
milk?
Babies often show thev have had enough milk
simply by falling asleep. But before thev go to sleep,
they may unclench their fists, smile, refuse to drink
anymore or just arch their back. Don’t force the
baby to feed anv more if it doesn’t wain to. Learn to
accept your babv’sjudgement about when and how
much it wants to feed.
12.
Can a woman with small breasts produce enough
milk?
Some women with small breasts worry about their
capacity to produce enough milk for their baby’s
need. The size of the breasts have no relation to their
capacity to produce milk. Women with small
breasts can and do produce more than enough milk
for their babies. Worry will only reduce the flow
of milk. What is important is not the size of your
breasts, but allowing your baby to suckle frequently.
Frequent suckling will stimulate your breasts to
produce more milk. This is the secret to successful
breastfeeding.
13.
Can a mother breastfeed while having her
periods?
There is no reason why a mother should not breast
feed during her periods, since this will not harm
her or the baby. Some mothers say that their babies
are temperamental when they have their periods.
This is quite likely due to the mother’s own
menstrual tension being communicated to the
baby. There is no difference in the mother’s milk,
during her periods.
14.
Can a mother breastfeed even when she is
ill?
Yes, a mother can continue breastfeeding her baby
even while she is ill, without harming the baby. In
most cases, the baby will get the protection against
the mother’s illness from the antibodies present in
breast milk.
Most medicines taken for illnesses do pass into the
breast milk but in such small quantities, that they
are unlikely to harm your baby. Consult a doctor
who will prescribe medicines which are less likely to
harm the baby. The doctor will also advise die
mother to continue breastfeeding.
However if the mother has high temperature,
jaundice or septacaemia, the doctor will advise her
to discontinue breastfeeding until she recovers. A
mother who has been advised to stop breastfeeding
during an illness should however, express her milk
regularly and throw it away until she has fully
recovered from the illness. This practice will ensure
that her flow of milk is not reduced. On recovery
she should resume breastfeeding the baby.
During the period when she has been advised to
discontinue breastfeeding, the mother can give the
baby fresh cow, goat or buffalo milk or even milk
from the local dairy centre. Do not dilute this milk.
Generally speaking in most common illnesses, a
mother can continue breastfeeding without any ill
effects on the baby.
15.
Should a
ill?
baby
be breastfed even
when
Yes, your baby can certainly be breastfed even when
it is ill. In fact it is very’ important that you continue
breastfeeding while the baby is ill because your milk
will provide the baby with antibodies to protect it
from other illnesses which can set in when it is
already weak. Breast milk will also give the baby the
nourishment and strength to recover from the
illness.
Do not stop breastfeeding when the baby is ill,
unless your doctor advises you to stop. But this is
rare. Unless your baby is so ill that it is not allowed
milk, the baby will do better drinking breast milk
than any other milk. Breast milk is much easier for
the baby to digest. Besides, the baby will recover
faster from vomiting, diarrhoea and dysentry if it is
given breast milk.
16.
Can a mother
pregnant?
breastfeed
when
she
is
\es, a modier can certainly continue to breast
feed her baby all through her pregnancy without
any ill effects on either the breastfed baby, the baby
in the womb or herself. However, a pregnant
woman who is breastfeeding her earlier child
should eat slightly more for the sake of the breast
fed baby and herself as well as for the baby growing
in her womb. All three require good nourishment
during this period.
17.
i- :i possible that breastmilk may not suit my
baby?
Babies are rareq; allergic to breast milk. Nothing
could ’>>• more suitable than what Nature intended
to feed your baby. In tact animal milk and powder
milk fire unnatural for the baby’s system. Il has
been found that bottle fed babies arc more likely to
suffer from allergies like asthama and eczema.
Bottle fed babies arc also more prone to diarrhoea.
Do breastfeed vour baby. Breast milk is the safest
and most nourishing food available for your baby.
18.
What should a mother do about breastfeeding
if she has had a caesarian operation?
Except in rare cases, there is no reason why a
woman who has had a caesarian operation cannot
breastfeed as successfully as die woman who has
had a normal delivery. However, after a caesarian
operation you are bound to be in pain. If you are
determined to breastfeed, then you would have to
put your pain and discomfort aside and insist that
your baby be brought to you as soon as you are
awake. As a bonus, breastfeeding your baby will
help to compensate for some of the disappoint
ment you may feel not having experienced a
normal childbirth.
Unlike a mother who has had a normal delivery,*
you will not be able to breastfeed immediately after
childbirth as you will be under the effect of
general anaesthesia. However, insist that your baby
be brought to you as soon as you are awake and
kept with you. Also you should insist that you do
not want your baby to be bottle fed. Put the baby to
the breast whenever it cries for a feed, instead of
feeding it at fixed schedules. It is vital that you put
the baby to the breast as soon as you are awake, so
that your baby is not deprived colostrum. Frequent
suckling will stimulate your breasts to produce
more milk. In a day or so, your milk supply will
settle down to suit your baby’s need.
At first you may face a problem deciding on a com
fortable position to breastfeed. Sitting up after a
caesarian operation can be painful. However, don’t
let this problem put you off breastfeeding. Lie on
your side and let the baby suckle your breasts. After
the baby has had its fill on one side, ask.someone to
help you (urn to the other side and continue
breastfeeding from the other breast.
Remember breast milk is the best and complete
food for your baby, besides being the safest and
most hygienic. For vour baby’s sake, put your pain
and discomfort aside and insist on breastfeeding
your baby as soon as you are awake. Do not let
people discourage you from breastfeeding. After
all, as a mother, you would not like to deprive your
newborn of the best food available.
19.
Should a baby be kept with the mother while
she is still in the hospital or nursing home?
Every mother should insist that her newborn is kept
witlt her in the same room, no matter where she
is—at home, hospital or the nursing home. This is
called ‘rooming in’.
Many hospitals and nursing homes keep the
newborn separately for the first fe.ty days. Al
though a nurse will bring the baby to the mother
in the course of the day, she may give the baby an
occasional ‘top’ or bottle feed. Even a single botde
feed of milk powder can disrupt the formation of
the normal suckling habit and reduce the mother’s
milk supply.
This happens because suckling the mother’s nipple
requires greater effort on the baby’s part. Nature
intended it to be this way. This extra effort by the
baby helps to stimulate the breasts to start and
increase the flow of milk. On the other hand,
suckling the feeding botde is much easier. If your
baby gets used to suckling from a feeding botde, it
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will not exert much pressure while suckling your
breast. If the babv doesn’t suckle hard enough, it
will not stimulate the breasts enough to produce
more milk. This can reduce the flow of milk from
your breasts. Therefore it is vital that every mother
insists that her baby is kept with her soon afterbirth
and is exclusively breastfed. Not only would the
baby get colostrum that flows for the first day or
two, but frequent suckling whenever the baby cries
for a feed will ensure a good flow of milk.
20.
How can a working mother continue breast
feeding after she returns to work?
Most working mothers are entitled to three months
maternity leave. A mother who is keen to breastfeed
her baby should take as much of this leave after
deliver}'. This will ensure that at least for the first
three months of life, her baby is exclusively breast
fed while she is at home. During this period, do not
make the mistake of getting your baby used to
bottle feeds before vou return to work. Just because
you have to return to work, docs not mean that
botde feeding is the only answer to feeding your
baby.
The problem of breastfeeding arises during the
working hours when the mother is away at work.
However, if she is determined to breastfeed, she
can hand express her breasts in the morning before
leaving for work. Store this expressed -milk in a
clean covered container which has already been
properly sterilized in boiling water. This pre
caution would ensure that no germs enter the
baby’s body. Breast milk can be stored in the
refrigerator for a few hours, and reused while the
mother is away. Do not warm expressed milk
directly over the fire. To warm this milk put the
container in a bowl of hot water. A family member
who stays at home with the baby can give the feed,
using a' clean spoon.
Once the mother returns home, she can breastfeed
her baby. A working mother who wishes to breast
feed should follow this practice: breastfeed the
baby before leaving for work; hand express your
milk and store this milk which can be reused in
your absence, and resume breastfeeding when you
return. This will ensure that your baby is not
deprived of your milk during these crucial months
of life. Expressing your milk everyday before leav
ing for work acts as a double bonus. Besides
6
providing the baby with the best nourishment
available, it also prevents your milk flow from
reducing.
Some mothers may complain that expressing
breast milk every morning would involve much
time and effort, just when she'has so many other
household chores to finish. But it you balance the
benefits of continuing breastfeeding with this extra
effort and time, you will be convinced to make
the right decision—to continue breastfeeding. You
will also have die satisfaction that your baby is getting
the' best possible nourishment. After all, breast
milk is the best and complete food for the baby
during the first 4 to 6 mondis of life. Remember,
there can be no other substitute for it.
21.
How do 1 express milk from my breast?
Wash your hands before you express the milk. Use
both hands to squeeze gently from the base of the
breast towards the areola (the dark area around the
nipple) and the nipple. Then squeeze the breast
and the areola between the fingers and the thumb
till the milk flows out.
Collect this milk in a clean cup or container which
has been boiled previously. Cover the container
and store the milk in the refrigerator. Expressed
milk can be stored in die refrigerator and reused
within a few hours. If there is no refrigerator in your
home, store the expressed milk in a cool place. Milk
which is kept outside a refrigerator must be used
within 2 to 3 hours after being expressed.
To warm the milk, put the container in a bowl of
hot water. Do not warm expressed milk direcdy
over the fire. Use a clean spoon to feed the baby.
22.
What should every nursing mother know
about cleanliness and care of her nipples and
breasts?
Every morning while having a bath, wash your
nipples and breasts with plain water. Avoid using
soap on your breasts and nipples as this would
remove the natural oils secreted by your breasts to
keep them from cracking. While you do not have
to wash your breasts and nipples before a feed, do
remember to wash them after and dry them well.
This precaution will prevent your nipples from
cracking. Cracked or sore nipples can be painful.
The important thing to remember is to wash vour
asts and nipples with water and keep them dry
between feeds.
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■
What should a nursing mother eat to maintain
a good flow of milk?
There is no evidence that any food, drink or
vitamins will increase or decrease the flow of milk,
as long as you eat enough of a variety of foods.
However to produce enough milk for the baby and
to maintain your own health, you should eat a little
extra of whatever you eat normally. An extra
helping of rice or chapati, dal, fresh green leafy
vegetables, fish, eggs, meat and fresh frtfits will give
you all the nourishment that you need to produce
more than enough milk for your baby and will help
you maintain your own health.
It is sensible to eat according to your appetite and
try' not to lose weight—the fat stored in your body
during pregnancy will slowly be lost when you
breastfeed. Avoid overeating. A mother who eats
sensibly will not only provide her baby with plenty
of milk, but will also ensure that her own body isn’t
being drained of food resources to meet her baby’s
need.
Even poorly nourished mothers manage to breast
feed their babies adequately for the first 4 to 6
months before extra food is required for the
normal growth and development of the baby.
However, these mothers breastfeed at the cost of
their own bodies—their bodies lose calcium and
proteins. The more babies these women bear and
feed, the poorer their health becomes.
’ How much extra should you eat while nursing?
You should eat slightly more than you do when you
are not pregnant. Is there anything you should eat
more of when feeding the baby? No. Assuming that
you are eating a variety of food in your normal daily
diet, just eat slightly more of everything. This will
provide enough nourishment both for your baby
and you.
24.
Is it true that vegetarian mothers cannot
produce enough milk and so should not breast
feed?
No, this is not true. A vegetarian mother can
breastfeed successfully and produce enough milk
for her baby. Traditionally in most Indian homes
people eat a vegetarian diet, and women through
the ages have lived and reared their children while
eating a vegetarian diet. As long as the nursing
mother eats slighdy more than what she eats
normally when she is not pregnant, she will
produce more than enough milk for her baby.
There is absolutely no reason to fear that a woman
eating a vegetarian diet will deprive her baby of
adequate nourishment. A vegetarian diet which
contains a variety of foods like rice or chapati, dal,
fresh green leafy' vegetables, ‘paneer’, curd and
fresh fruits will provide enough nourishment both
to produce enough milk and to maintain the
mother’s own health.
25.
Should a nursing mother drink extra water so
that her milk is not too thick and is easy for
the baby to digest?
The amount of water that a mother drinks has no
relation to the consistency of breast milk, which
differs from person to person. Some mothers fear
that their milk is too watery', while others feel their
milk is too thick for the baby to digest. The truth is
that the consistency of breast milk has nothing to
do with its quality. Breast milk, whether thin or
thick is perfect for your baby.
In summer, a nursing mother finds herself very
thirsty. This is hardly surprising, considering that
the baby is taking a great deal of milk from you
everyday. Don’t force yourself to drink extra water,
just drink as much as you want to.
26.
Will breastfeeding spoil my figure?
No, breastfeeding will not spoil your figure. On the
contrary, breastfeeding is Nature’s way of restoring
your figure. During pregnancy a woman’s body
stores up fat in preparation for nursing the baby.
This extra fat is used up when the mother starts
breastfeeding. In fact, breastfeeding ‘helps the
mother lose the extra weight she gains during
pregnancy. In addition, the womb which has
stretched to hold the growing baby, also regains its
normal size when a hormone is released during
breastfeeding.
Is breastfeeding effective in delaying the next
pregnancy?
It has been found that frequent and regular breast
feeding may help to delay the next pregnancy.
Breastfeeding alone, however, will not provide
27.
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complete protection. A mother who breastfeeds
should also take some other precaution to avoid
pregnancy.
body needs additional nourishment. Your baby is
now ready to eat soft foods. You can also give the
baby fresh orange, musami or lime juice.
28.
JO. What precautions should I take when preparing
a meal or feeding my baby?
When should a breastfed baby start eating
softfoods? What should it eat and how do I start
my baby on these foods?
For the first 4 to 6 months, breast milk is your
baby's best and complete nourishment. Alter this,
its growing bodv needs additional nourishment.
You don’t need to buy special foods for your baby.
You can prepare them at home inexpensively from
die same things you use for the family meal.
However, your babv still needs breast tnilk in
addition to its new diet, so continue breastfeeding
as long as you can.
After the first 4 to 6 months, your baby must also
get a share of the family foods. Give the baby one
type of food at a time until it learns to enjoy a variety
of foods. Start with small quantities and gradually
increase them to suit its age and appetite. Feed the
babv frequently.
Your baby will grow well on foods like kichari,
dalia, da] mixed with rice or chapati, lightly cooked
fresh green leafy vegetables, half boiled eggs and
fish. Fresh fruits like papaya and banana along with
fresh orange, musami or lime juice are also good
for the growing baby.
Mash the food well to make it easy for the baby to
swallow and digest. Add a little ghee, butter or oil.
This makes the food tastier amd gives extra
energy.
Soft foods should be given between breastfeeds.
Encourage the baby to feed itself with its fingers.
This is part of its growing and learning experience.
By one year, your baby is ready to eat the food you
prepare for the rest of the family.
29.
Should a breastfed baby also -be given extra
vitamins and juices? At what age should these
be given?
As long as the nursing mother is healthy and eats
enough of a variety of foods, there is no need to give
extra vitamins and juices to a breastfed baby for the
first 4 to 6 months of life. Breast milk will give the
baby all that it needs during this period.
Once the baby is 4 to 6 months old, its growing
8
Most mothers know the importance of hygiene. But
often a busy mother may overlook some details of
cleanliness. Can any mother afford to take this risk?
The hidden dangers—germs that you cannot seecan lead to illnesses in the family. A baby is more
likely to fall ill. You need to be extra careful if there
is a baby' at home.
Keep your home and surroundings clean. Germs
breed in dirt and contaminated food and water,
causing diarrhoea, and spreading diseases like
cholera, dysentry and gastroenteritis. Drinking
water must be strained through a clean cloth,
boiled and cooled. Store this water in a clean
covered container. Give your baby food which is
freshly prepared. Wash your hands before you
cook the meal or feed the baby. Keep utensils clean.
Wash diem well before and after use, and rinse
under running water.
JI. Are special baby foods available in the
market better than soft foods prepared at
home?
Special foods for babies available in the market are
based on a mixture of powdered milk with some
carbohydrates like wheat and rice. These foods
which are cereal and milk based are expensive. On
the other hand, a wise mother can provide her
growing baby with all the nourishment it needs
with the same things she uses to make the family
meal. Instead of spending large sums of money on
tins of baby foods, she can buy good wholesome
food for the entire family, including the baby. Soft
foods prepared at home give the baby a better
variety of foods, in addition to providing all the
nourishment it needs.
J2. Should I give soft foods before or after a breast
feed?
Soft foods should be given between breastfeeds,
preferably a couple of hours after a breastfeed. This
is advised because a baby will not make an extra
effort to eat soft foods when it is very hungry. This is
because suckling the mother's breast comes naturally
to a baby, whereas it has to learn to eat soft foods. A
hungry baby will be less interested in eating soft
foods on an empty stomach. Having had a breast
feed a couple of hours earlier, the baby will not be
too hungry when offered soft food and may show
more interest in this food than otherwise.
On the other hand, if you offer the breast im
mediately after it has been fed soft food, the baby
will not suckle the mother’s breast strongly since it
is not hungry at that moment. When the baby fails
to suckle strongly, it will not stimulate the breasts to
produce .more milk. Eventually the flow of milk
may reduce. Therefore, breastfeed your baby and
offer it soft foods a couple of hours later. Give the
next breastfeed a couple of hours after its last meal
of soft ioods. In this manner the baby will continue
to get the double benefits of its mother’s milk as
well as soft foods.
33.
Should a mother continue soft foods when the
baby is ill?
It is incorrect to stop feeding a baby when it is ill. in
fact the baby needs nourishment even more so
to recover from its illness. Food will give it the
strength to fight other illnesses which can set in
when the body is already weak.
Soft foods like kichari, dalia, rice or chapati mixed
with lightly cooked dal and vegetables will not harm
the babv. Sometimes when the baby is ill, it does
not feel hungry or may prefer to eat food other than
what it normally eats. While recovering from its
illness, the baby’s appetite will improve. Give the
baby slightly more than what it normally eats
because it needs additional nourishment to regain
its health.
34.
Why does my baby have diarrhoea while teething?
Is it because it is teething or thefact that I have
started giving it soft foods?
Often mothers tend to associate teething with
diarrhoea. This is incorrect. Diarrhoea occurs
when the baby eats contaminated food or drinks
water which is contaminated. Moreover when a
babv is teething, it tends to pick up things lying
around- the house and chew on it. These objects
can carry germs into its body and cause diarrhoea.
If you prepare soft foods hygienically, there is no
reason why the baby should have diarrhoea.
Introducing soft foods will not cause diarrhoea, as
long as they are well prepared. Wash your hands
before you make the meal or feed the baby. Use
fresh food. Use clean drinking water. Keep the
utensils clean. These precautions will help to
prevent diarrhoea.
35. What is diarrhoea?
Diarrhoea is not a single disease. It is a symptom
that accompanies intestinal disorders. When a baby
has diarrhoea, it passes frequent watery stools
which may be foul smelling. Diarrhoea causes loss
of vital body fluids and salts. In somes cases, the
stools may also have blood and mucus.
36.
Is diarrhoea. dangerous?
Yes, diarrhoea can be dangerous especially for
babies and young children below two years. If you
fail to replace the fluids and salts that a baby loses
during diarrhoea, it can lead to a dangerous
situation called ‘dehydration’. Remember pro
longed diarrhoea can lead to dehydration and even
death. Do not take diarrhoea lightly. Unfortunately
some mothers think diarrhoea is not serious. This is
not true. Diarrhoea can become very serious if you
neglect it.
37.
Is it true that breastfed babies have less chance
of getting diarrhoea?
Yes, it .is true that babies who are breastfed
exclusively rarely have diarrhoea. Breast milk is not
only free of germs but also helps to prevent the
growth of those germs that cause diarrhoea. It has
been found that bottle fed babies have diarrhoea
six times more often than breastfed babies. This is
because the feed is not prepared hygienically. For
a bottle feed to be safe, you need to take many pre
cautions, like sterilizing the feeding botde and
nipple and boiling the water to make the feed.
Breastfeeding takes care of all this trouble. Breast
milk is the safest and most hygienic way to feed
your baby. Breastfeed as long as you can, even
when the baby has diarrhoea. Breast milk will give
the baby all the nourishment it needs to recover,
besides being easier for the baby to digest. In
9
addition, antibodies in your milk will protect the
baby from other illness which can set in when the
baby is already weak from diarrhoea.
38.
What should I do when my baby has diar
rhoea?
Give the home prepared salt and sugar solution or
the ORS solution every time it passes a water stool.
Continue giving this solution until it passes normal
stools. Some mothers simply stop feeding their
babies during diarrhoea. This is not good for the
baby for it needs nourishment. Give the baby
lightly prepared foods like kichri, dalia or rice and
curd.
There is a simple and inexpensive treatment that
every parent can administer at home. Start the
treatment at the first signs of diarrhoea.
41.
In a glassful of boiled and cooled water, add a pinch
of salt (% teaspoon). Make sure this solution is not
saltier dian your tears. Then add two teaspoons of
sugar or ‘gur’ and dissolve it well. The baby may
refuse to drink this solution, but insist on giving the
solution frequently in small quantities.
Diarrhoea is caused by germs which breed in
contaminated food and water, dust and unsanitary
surroundings. These germs enter the baby’s body
through contaminated food or water.
It is important that the baby drinks a glassful of this
solution every time it passes a watery stool. This is
approximately the amount of liquid it loses every'
time it passes a watery stool. So make sure that you
replace die fluids it has lost. Continue giving this
solution until the babv stops passing watery stools.
Plain water which is boiled and cooled, rice kanji or
coconut water can also be given in addition to the
salt and sugar solution. Remember to continue
breastfeeding and normal feeding during diar
rhoea. If the baby’s condition doesn’t improve
within two days, contact your doctor immediately.
39.
What is ORS?
ORS stands for oral rehydration salts. These salts
are specially prepared to deal with the loss of vital
salts from the body. Mixed with boiled and cooled
water, this ORS solution becomes a good rehydra
tion fluid. They come in packets and are available at
a chemist. Follow the instructions on the packet to
make the solution.
There are simple measures that you can' take to
prevent diarrhoea. Keep your home and surroundings clean. Drinking water must be strained
through a clean cloth, then boiled and cooled.
Store this water in a clean covered container. Keep
your utensils clean. Wash them before and after use
and rinse under running water. Give your baby
freshly cooked food. Wash your hands before you
cook the meal or feed the baby. All clothes includ
ing undergarments and bed linen must be clean
and fresh. Finally continue to breastfeed your baby
as long as you can, even when the baby has
diarrhoea. Breast milk is the safest and most
hygienic way to feed your baby.
42.
Should I give tonics or special foods when the
baby has diarrhoea?
You don’t have to give a tonic or any special kind of
food when the baby has diarrhoea. Just make sure
that it drinks plenty of liquids and eats well when it
has diarrhoea. When the baby has diarrhoea, you
need to replace the fluids.it loses. It also needs
good nourishment to regain its strength both to
recover and to fight against other illnesses which
can set in when it is already weak.
10
Would a breastfed baby catch a cold ifthe mother
drinks cold water?
No, this is not true. Breast milk comes at the right
temperature to suit the baby, irrespective of the
cold or hot drinks the mother consumes.
43.
40.
What should I do to prevent my babyfrom getting
diarrhoea?
Since breast milk contains antibodies, does this
mean that a breastfed baby does not require
immunization against common childhood
diseases?
Although antibodies present in the mother’s milk
do give immunities to some common childhood
diseases, every baby should be immunized
regularly to completely eliminate the risk of these
diseases. Table 1 gives the immunization schedule.
Remember that immunization is effective only
when a regular and complete dose is given. The
w
baby should not be ill at die time of immunization.
Breastmilk contains mother’s natural immunities to
protect the babv against illness. Breastfeed your
baby as long as vou can. In addition follow the
immunization schedule to completely eliminate
die risk of common childhood diseases like tuber
culosis, diphtheria, whooping cough, tetanus,
poliomyelitis and measles.
TABLE 1 IMMUNIZATION SCHEDULE
WHAT
3-9 months
3-9 months
protect against tuberculosis
BCG vaccine
3 doses of DPT and Polio vaccine protect against diphtheria, whooping
cough, tetanus & poliomyelitis
at intervals of 4-6 weeks each
protect against measles
Measles vaccine
9-12 months
1‘.-2 years
5-6 years
!
WHY
WHEN
1st booster for DPT and Polio
DT booster
protect against diphtheria & tetanus
UNITED NATIONS CHILDREN'S FUND
73 LODI ESTATE, NEW DELHI - 110003
Math
CH I
GIVE YOUR BABY THE BEST
START IN LIFE
1. Should I breastfeed my baby?
Yes, even,- mother should breastfeed her baby.
Breast milk is nature’s first gift to your babv. and
diere is no other substitute for it. For the first 1 to 6
months, breast milk is your baby's best and
complete food. Do not be misled by people who
suggest powdered milk ‘in case you think you do
not have enough milk’. It has been found that
almost all mothers are capable'of producing more
than enough milk for their baby’s need.
Nature in all its wisdom has ensured that you can
breastfeed successfully. All you need is the deter
mination to breastfeed, and faith in your own ability
to breastfeed successfully. Remember that breast
milk has many qualities which make it unique from
all other artificial milks available.
2. Will I be able to breastfeed successfully?
A common reason mothers give for stopping
breastfeeding is the fear that they do not have
enough milk, and so they introduce their babies to
artificial feeds in the first few days after birth.
Research shows that in practice, almost every
mother can breastfeed successfully. Rarely is there
any physical reason for being unable to feed the
baby naturally. The most important thing to
remember is that the mother must want to breast
feed, have confidence in her ability to breastfeed
successfully and must not lose hope.
Further, studies have shown that women who want
to breastfeed actually produce more milk than
those who don’t want to. or are indifferent about
breastfeeding their babies. Many women fail to
breastfeed successfully, even though they want to,
because they believe, incorrectly, that they do not
have enough milk for their baby’s need. The truth is
that almost ail mothers are capable of producing
more than enough milk for their baby’s need.
J. What is Colostrum? Is it important for my
baby?
For the first day or two, the milk that flows from the
breast is called colostrum. This first milk is extreme
ly nourishing for the newborn. What makes
colostrum even more special is the fact that this
first milk is full of antibodies produced by the
mother. These antibodies protect the newborn
against some diseases and infections at a time when
the baby is particularly vulnerable. Later milk also
contains these antibodies, but not as much as the
first milk. In addition, colostrum also has certain
properties that prevent allergic diseases like
asthama and eczema which are more common in
botdefed babies.
Traditionally, in many Indian homes, colostrum is
thrown away. Today we have learnt that in actual
fact, colostrum is extremely valuable to the new
born. Throwing away the colostrum deprives the
newborn of the best possible nourishment avail
able, aS well as the protection that it offers against
disease. Colostrum is very rich in proteins,
minerals and vitamins. In fact, colostrum is just
what the newborn needs soon after its birth.
No matter where a mother delivers her baby, at
home, hospital or the nursing home, she should
insist that the baby is kept with her in the same
room. This way she can ensure that her baby gets
the benefits of colostrum. Put the baby to the breast
soon after birth. The sooner the baby starts suckl
ing the breast, the sooner and better the milk will
flow. In addition, it will receive the benefits of
colostrum which flows only for the first day or two.
According to many doctors, colostrum has life-long
health preserving benefits.
4.
How often should a baby be breastfed in a
day?
Babies usually cry when they are hungry. Put your
baby to the breast each time it cries for a feed. This
demand feeding is a better way to feed your baby
instead of fixed schedules.
Babies could also cry for some other reasons, such
as if their nappy is wet or if die clothes are too tight.
Having checked that none of these is rhe source of
trouble, you should interpret the baby’s cry as its
demand to be breastfed.
Your baby is a special person, an individual unlike
other babies. It is not just a hungry stomach to be
filled at regular intervals. Once you accept that die
baby may' ask for a feed at different times, depend
ing on when it is-hungry, you are well on youi way
towards breastfeeding successfully. If y'ou worry'
each time it cries for a feed too soon, you are more
likely' to lose your milk. This happens because
worry' can interfere with the ‘let down’ of the milk
from your breasts.
While some babies setde down to a routine of
demand feeding after a few weeks, others don’t. So
do not compare your baby with other babies. Just
breastfeed your baby when it cries for a feed.
As the baby grows it may ask for fewer feeds and
may setde down to a regular demand routine, every
two, three or four hours. Sometimes your baby may
demand a feed more often than other dmes. This
could be for many reasons: the baby may be extra
hungry', growing rapidly, teething or is just upset. If
the baby needs extra feeds, your own milk supply
will adjust to its needs if you let the baby suckle as
much as it wants to and whenever it demands a
feed.
5.
How long should each breastfeed last?
Let your baby tell you how long it needs to suckle
2
your breasts to get its fill. A hungry baby will cry’ lot
milk. The old rule of 10 minutes on each breast was
created because that was roughly the average time
that a baby takes to feed. But each baby is different.
So while some babies take less than 10 minutes to a
side to get their fill, others may take longer.
During the first few months, you may find that youi
baby wants a feed very' frequently. This is not un
usual and is the baby’s way of increasing your milk
supply to suit its growing needs. People may tell
you that a baby gets all the milk that it needs in the
first few minutes at each breast. But all babies are
not alike. A lot will depend on how vigorously the
baby suckles, the strength of your ‘let down’ reflex
and the time taken for the ‘let down’ or start of the
milk flow.
Remember that some babies enjoy suckling even if
they have had their fill. There is no reason to stop
this unless you have some other work to do, or if
you have sore nipples. This ‘comfort suckling’ is
considered by many' experts to be an important
factor in the child’s emotional development.
When y'our baby’ has had its fill on one breast, in
other words, when it loses interest in feeding,
change it to the other side. Let the baby' continue
feeding on the other breast as long as it wants to.
There are times when the baby will feel less hungry,
is sleepy or just tired and may not want to suckle
very' long. Don’t worry about this, and don’t force
the b.aby to feed. Just offer your breast after a little
while.
6.
How does a mother know if her baby is getting
enough milk?
It is true dtat when you breastfeed you cannot
actually see how much milk the baby drinks.
However, if your baby sleeps well, is healthy, active
and playful when awake and gains weight steadily
each mondt, then you can be sure that your baby is
getting enough milk for its nourishment and
growth.
7.
How can I increase the flow of milk in my
breasts?
The baby’s suckling is the best way to start and
increase the flow of milk in your breasts, and the
sooner the baby is put to the breast, the sooner and
better will be the flow of milk. Let the baby suckle as
frequently as possible because the more often a
baby suckles the breast, the better it stimulates the
breast to produce more milk. This is Nature’s secret
to start and increase the flow of milk to meet your
baby's growing needs.
Sometimes emotions like embarrassment, tension,
or fatigue can also interfere with the ‘let down’ of
the milk. A mother should therefore, relax and sit
comfortably when she feeds her baby.
"When the baby suckles, it stimulates two hormones
which are released into the mother’s bloodstream.
One of these hormones stimulates a strong flow of
blood through the breasts and activates the milk
making tissue. The other hormone causes the
breasts to push out or ‘let down’ the milk from the
breasts. This is generally felt as a ‘pins and needles’
sensation or a full feeling in the breasts. If the milk
doesn’t "let down’, vour baby will not get all the
milk that is available in the breasts. Fortunately
Nature has ensured that when the baby suckles
frequently, the ‘let down’ reflex works well.
8.
What should I eat to increase the flow of milk in
my breasts? Are there medicines to increase this
flow?
There are no special foods or medicines to improve
the quality and quantity of breast milk. To breast
feed successfully and to maintain her own health, a
nursing mother should eat slightly more of the food
she normally eats. There is no need to eat anything
special. An extra helping of rice or chapati, dal,
green leafs’ vegetables and fresh fruits will give the
nursing mother all the nourishment she needs to
produce enough milk for her baby and to maintain
her own health. Eggs, fish and meat are also good.
What is important is to eat slightly more of every
thing that she normally eats, rather dtan eating
anything special while nursing her baby.
Finally be assured, you can increase your milk
supply. Nature has made sure that when the baby
suckles the breast frequendy, the milk will flow
well. All you need is the confidence in your natural
ability to breastfeed successfully. Eat and rest well.
These early months can be a challenge, demanding
much patience and determination on your part. So
do relax and enjoy your baby. Remember that not
only is your baby receiving the best food available,
but also both your baby and you arc building a
happy and secure relationship during this period.
9.
How should a mother hold the baby while breast
feeding?
There is no ideal position to hold the baby while
breastfeeding. The main thing is to make yourself
comfortable because you will be in that position for
some time, and try’ to make the baby comfortable.
Pain and discomfort can reduce the ‘let down’ of
milk.
Support the baby’s weight with a pillow on your
lap. Another pillow under the arm supporting the
baby will also help.If you are sitting, it is easier to
feed if you sit upright and lean slightly forward.
Hold the baby with its chest and stomach against
you, so that it doesn’t have to turn its head around
and can feed comfortably. Some babies like to have
something to hold on to while feeding—give the
baby your finger to hold onto. At night, lie on your
side and breastfeed the baby.
Don’t push the baby’s mouth onto your nipple.
This could frighten the baby’. Instead, stroke the
side of its mouth with your nipple. If your breast is
very full, you may have to hold it back so that the
baby’s nose is not smothered. But don’t bother to
hold your nipple or breast once the baby starts
suckling. Expressing a little milk from a full breast
will soften it enough to enable the baby to hold on.
When breastfeeding, part of the areola (the dark
area around the nipple) should go into the baby’s
mouth as the milk reservoirs are under the areola
and need to be emptied by the baby’s suckling. If
only the nipple goes into the baby’s mouth, not
enough milk will flow out. The baby would have to
suckle extra hard and this could lead to sore
nipples. If you have an extra large areola, hold it
between the finger and thumb and squeeze them
together. This will make the areola flatter and easier
for the baby to take in its mouth.
You may notice that at times your baby stops
suckling and looks around. This happens because
the ‘let down” Causes the milk to be spurted in an
uneven flow. Several spurts of milk come out, and
then there is a short pause before the milk flows
again. Your baby is adapting to the flow of your
milkand its breathing pattern is also altered to fit in
with this drinking pattern.
10.
How should a mother stop a feed?
Some babies simply let the nipple, go when they
have had enough to drink, while others have to be
gently removed from the breast. Some babies also
like to suckle even after thev have had theif fdl. This
is called ‘comfort suckling.’ According to many
doctors, this should be encouraged because it helps
the emotional development of the baby.
Do not abruptly pull the baby’s mouth away from
vour breast while it is feeding. The force could
damage the nipple and the areola, apart from
frightening the babv. Instead, put the tip of your
little finger in the corner of the baby’s mouth and
gently draw the babv away.
11.
How can I tell when the baby has had enough
milk?
Babies often show thev have had enough milk
simply by falling asleep. But before thev go to sleep,
they may unclench their fists, smile, refuse to drink
anymore or just arch their back. Don’t force the
baby to feed anv more if it doesn’t wain to. Learn to
accept your babv’sjudgement about when and how
much it wants to feed.
12.
Can a woman with small breasts produce enough
milk?
Some women with small breasts worry about their
capacity to produce enough milk for their baby’s
need. The size of the breasts have no relation to their
capacity to produce milk. Women with small
breasts can and do produce more than enough milk
for their babies. Worry will only reduce the flow
of milk. What is important is not the size of your
breasts, but allowing your baby to suckle frequently.
Frequent suckling will stimulate your breasts to
produce more milk. This is the secret to successful
breastfeeding.
13.
Can a mother breastfeed while having her
periods?
There is no reason why a mother should not breast
feed during her periods, since this will not harm
her or the baby. Some mothers say that their babies
are temperamental when they have their periods.
This is quite likely due to the mother’s own
menstrual tension being communicated to the
baby. There is no difference in the mother’s milk,
during her periods.
14.
Can a mother breastfeed even when she is
ill?
Yes, a mother can continue breastfeeding her baby
even while she is ill, without harming the baby. In
most cases, the baby will get the protection against
the mother’s illness from the antibodies present in
breast milk.
Most medicines taken for illnesses do pass into the
breast milk but in such small quantities, that they
are unlikely to harm your baby. Consult a doctor
who will prescribe medicines which are less likely to
harm the baby. The doctor will also advise die
mother to continue breastfeeding.
However if the mother has high temperature,
jaundice or septacaemia, the doctor will advise her
to discontinue breastfeeding until she recovers. A
mother who has been advised to stop breastfeeding
during an illness should however, express her milk
regularly and throw it away until she has fully
recovered from the illness. This practice will ensure
that her flow of milk is not reduced. On recovery
she should resume breastfeeding the baby.
During the period when she has been advised to
discontinue breastfeeding, the mother can give the
baby fresh cow, goat or buffalo milk or even milk
from the local dairy centre. Do not dilute this milk.
Generally speaking in most common illnesses, a
mother can continue breastfeeding without any ill
effects on the baby.
15.
Should
ill?
a
baby
be
breastfed
even
when
Yes, your baby can certainly be breastfed even when
it is ill. In fact it is very’ important that you continue
breastfeeding while the baby is ill because your milk
will provide the baby with antibodies to protect it
from other illnesses which can set in when it is
already weak. Breast milk will also give the baby the
nourishment and strength to recover from the
illness.
Do not stop breastfeeding when the baby is ill,
unless your doctor advises you to stop. But this is
rare. Unless your baby is so ill that it is not allowed
milk, the baby will do better drinking breast milk
than any other milk. Breast milk is much easier for
the baby to digest. Besides, the baby will recover
faster from vomiting, diarrhoea and dysentry if it is
given breast milk.
16.
Can a mother
pregnant?
breastfeed
when
she
is
\es, a modier can certainly continue to breast
feed her baby all through her pregnancy without
any ill effects on either the breastfed baby, the baby
in the womb or herself. However, a pregnant
woman who is breastfeeding her earlier child
should eat slightly more for the sake of the breast
fed baby and herself as well as for the baby growing
in her womb. All three require good nourishment
during this period.
17.
i- :i possible that breastmilk may not suit my
baby?
Babies are rareq; allergic to breast milk. Nothing
could ’>>• more suitable than what Nature intended
to feed your baby. In tact animal milk and powder
milk fire unnatural for the baby’s system. Il has
been found that bottle fed babies arc more likely to
suffer from allergies like asthama and eczema.
Bottle fed babies arc also more prone to diarrhoea.
Do breastfeed vour baby. Breast milk is the safest
and most nourishing food available for your baby.
18.
What should a mother do about breastfeeding
if she has had a caesarian operation?
Except in rare cases, there is no reason why a
woman who has had a caesarian operation cannot
breastfeed as successfully as die woman who has
had a normal delivery. However, after a caesarian
operation you are bound to be in pain. If you are
determined to breastfeed, then you would have to
put your pain and discomfort aside and insist that
your baby be brought to you as soon as you are
awake. As a bonus, breastfeeding your baby will
help to compensate for some of the disappoint
ment you may feel not having experienced a
normal childbirth.
Unlike a mother who has had a normal delivery,*
you will not be able to breastfeed immediately after
childbirth as you will be under the effect of
general anaesthesia. However, insist that your baby
be brought to you as soon as you are awake and
kept with you. Also you should insist that you do
not want your baby to be bottle fed. Put the baby to
the breast whenever it cries for a feed, instead of
feeding it at fixed schedules. It is vital that you put
the baby to the breast as soon as you are awake, so
that your baby is not deprived colostrum. Frequent
suckling will stimulate your breasts to produce
more milk. In a day or so, your milk supply will
settle down to suit your baby’s need.
At first you may face a problem deciding on a com
fortable position to breastfeed. Sitting up after a
caesarian operation can be painful. However, don’t
let this problem put you off breastfeeding. Lie on
your side and let the baby suckle your breasts. After
the baby has had its fill on one side, ask.someone to
help you (urn to the other side and continue
breastfeeding from the other breast.
Remember breast milk is the best and complete
food for your baby, besides being the safest and
most hygienic. For vour baby’s sake, put your pain
and discomfort aside and insist on breastfeeding
your baby as soon as you are awake. Do not let
people discourage you from breastfeeding. After
all, as a mother, you would not like to deprive your
newborn of the best food available.
19.
Should a baby be kept with the mother while
she is still in the hospital or nursing home?
Every mother should insist that her newborn is kept
witlt her in the same room, no matter where she
is—at home, hospital or the nursing home. This is
called ‘rooming in’.
Many hospitals and nursing homes keep the
newborn separately for the first fe.ty days. Al
though a nurse will bring the baby to the mother
in the course of the day, she may give the baby an
occasional ‘top’ or bottle feed. Even a single botde
feed of milk powder can disrupt the formation of
the normal suckling habit and reduce the mother’s
milk supply.
This happens because suckling the mother’s nipple
requires greater effort on the baby’s part. Nature
intended it to be this way. This extra effort by the
baby helps to stimulate the breasts to start and
increase the flow of milk. On the other hand,
suckling the feeding botde is much easier. If your
baby gets used to suckling from a feeding botde, it
5
will not exert much pressure while suckling your
breast. If the babv doesn’t suckle hard enough, it
will not stimulate the breasts enough to produce
more milk. This can reduce the flow of milk from
your breasts. Therefore it is vital that every mother
insists that her baby is kept with her soon afterbirth
and is exclusively breastfed. Not only would the
baby get colostrum that flows for the first day or
two, but frequent suckling whenever the baby cries
for a feed will ensure a good flow of milk.
20.
How can a working mother continue breast
feeding after she returns to work?
Most working mothers are entitled to three months
maternity leave. A mother who is keen to breastfeed
her baby should take as much of this leave after
deliver}'. This will ensure that at least for the first
three months of life, her baby is exclusively breast
fed while she is at home. During this period, do not
make the mistake of getting your baby used to
bottle feeds before vou return to work. Just because
you have to return to work, docs not mean that
botde feeding is the only answer to feeding your
baby.
The problem of breastfeeding arises during the
working hours when the mother is away at work.
However, if she is determined to breastfeed, she
can hand express her breasts in the morning before
leaving for work. Store this expressed -milk in a
clean covered container which has already been
properly sterilized in boiling water. This pre
caution would ensure that no germs enter the
baby’s body. Breast milk can be stored in the
refrigerator for a few hours, and reused while the
mother is away. Do not warm expressed milk
directly over the fire. To warm this milk put the
container in a bowl of hot water. A family member
who stays at home with the baby can give the feed,
using a' clean spoon.
Once the mother returns home, she can breastfeed
her baby. A working mother who wishes to breast
feed should follow this practice: breastfeed the
baby before leaving for work; hand express your
milk and store this milk which can be reused in
your absence, and resume breastfeeding when you
return. This will ensure that your baby is not
deprived of your milk during these crucial months
of life. Expressing your milk everyday before leav
ing for work acts as a double bonus. Besides
6
providing the baby with the best nourishment
available, it also prevents your milk flow from
reducing.
Some mothers may complain that expressing
breast milk every morning would involve much
time and effort, just when she'has so many other
household chores to finish. But it you balance the
benefits of continuing breastfeeding with this extra
effort and time, you will be convinced to make
the right decision—to continue breastfeeding. You
will also have die satisfaction that your baby is getting
the' best possible nourishment. After all, breast
milk is the best and complete food for the baby
during the first 4 to 6 mondis of life. Remember,
there can be no other substitute for it.
21.
How do 1 express milk from my breast?
Wash your hands before you express the milk. Use
both hands to squeeze gently from the base of the
breast towards the areola (the dark area around the
nipple) and the nipple. Then squeeze the breast
and the areola between the fingers and the thumb
till the milk flows out.
Collect this milk in a clean cup or container which
has been boiled previously. Cover the container
and store the milk in the refrigerator. Expressed
milk can be stored in die refrigerator and reused
within a few hours. If there is no refrigerator in your
home, store the expressed milk in a cool place. Milk
which is kept outside a refrigerator must be used
within 2 to 3 hours after being expressed.
To warm the milk, put the container in a bowl of
hot water. Do not warm expressed milk direcdy
over the fire. Use a clean spoon to feed the baby.
22.
What should every nursing mother know
about cleanliness and care of her nipples and
breasts?
Every morning while having a bath, wash your
nipples and breasts with plain water. Avoid using
soap on your breasts and nipples as this would
remove the natural oils secreted by your breasts to
keep them from cracking. While you do not have
to wash your breasts and nipples before a feed, do
remember to wash them after and dry them well.
This precaution will prevent your nipples from
cracking. Cracked or sore nipples can be painful.
The important thing to remember is to wash vour
asts and nipples with water and keep them dry
between feeds.
7
■
What should a nursing mother eat to maintain
a good flow of milk?
There is no evidence that any food, drink or
vitamins will increase or decrease the flow of milk,
as long as you eat enough of a variety of foods.
However to produce enough milk for the baby and
to maintain your own health, you should eat a little
extra of whatever you eat normally. An extra
helping of rice or chapati, dal, fresh green leafy
vegetables, fish, eggs, meat and fresh frtfits will give
you all the nourishment that you need to produce
more than enough milk for your baby and will help
you maintain your own health.
It is sensible to eat according to your appetite and
try' not to lose weight—the fat stored in your body
during pregnancy will slowly be lost when you
breastfeed. Avoid overeating. A mother who eats
sensibly will not only provide her baby with plenty
of milk, but will also ensure that her own body isn’t
being drained of food resources to meet her baby’s
need.
Even poorly nourished mothers manage to breast
feed their babies adequately for the first 4 to 6
months before extra food is required for the
normal growth and development of the baby.
However, these mothers breastfeed at the cost of
their own bodies—their bodies lose calcium and
proteins. The more babies these women bear and
feed, the poorer their health becomes.
’ How much extra should you eat while nursing?
You should eat slightly more than you do when you
are not pregnant. Is there anything you should eat
more of when feeding the baby? No. Assuming that
you are eating a variety of food in your normal daily
diet, just eat slightly more of everything. This will
provide enough nourishment both for your baby
and you.
24.
Is it true that vegetarian mothers cannot
produce enough milk and so should not breast
feed?
No, this is not true. A vegetarian mother can
breastfeed successfully and produce enough milk
for her baby. Traditionally in most Indian homes
people eat a vegetarian diet, and women through
the ages have lived and reared their children while
eating a vegetarian diet. As long as the nursing
mother eats slighdy more than what she eats
normally when she is not pregnant, she will
produce more than enough milk for her baby.
There is absolutely no reason to fear that a woman
eating a vegetarian diet will deprive her baby of
adequate nourishment. A vegetarian diet which
contains a variety of foods like rice or chapati, dal,
fresh green leafy' vegetables, ‘paneer’, curd and
fresh fruits will provide enough nourishment both
to produce enough milk and to maintain the
mother’s own health.
25.
Should a nursing mother drink extra water so
that her milk is not too thick and is easy for
the baby to digest?
The amount of water that a mother drinks has no
relation to the consistency of breast milk, which
differs from person to person. Some mothers fear
that their milk is too watery', while others feel their
milk is too thick for the baby to digest. The truth is
that the consistency of breast milk has nothing to
do with its quality. Breast milk, whether thin or
thick is perfect for your baby.
In summer, a nursing mother finds herself very
thirsty. This is hardly surprising, considering that
the baby is taking a great deal of milk from you
everyday. Don’t force yourself to drink extra water,
just drink as much as you want to.
26.
Will breastfeeding spoil my figure?
No, breastfeeding will not spoil your figure. On the
contrary, breastfeeding is Nature’s way of restoring
your figure. During pregnancy a woman’s body
stores up fat in preparation for nursing the baby.
This extra fat is used up when the mother starts
breastfeeding. In fact, breastfeeding ‘helps the
mother lose the extra weight she gains during
pregnancy. In addition, the womb which has
stretched to hold the growing baby, also regains its
normal size when a hormone is released during
breastfeeding.
Is breastfeeding effective in delaying the next
pregnancy?
It has been found that frequent and regular breast
feeding may help to delay the next pregnancy.
Breastfeeding alone, however, will not provide
27.
7
complete protection. A mother who breastfeeds
should also take some other precaution to avoid
pregnancy.
body needs additional nourishment. Your baby is
now ready to eat soft foods. You can also give the
baby fresh orange, musami or lime juice.
When should a breastfed baby start eating
softfoods? What should it eat and how do I start
my baby on these foods?
JO. What precautions should I take when preparing
a meal or feeding my baby?
28.
For the first 4 to 6 months, breast milk is your
baby's best and complete nourishment. Alter this,
its growing bodv needs additional nourishment.
You don’t need to buy special foods for your baby.
You can prepare them at home inexpensively from
die same things you use for the family meal.
However, your babv still needs breast tnilk in
addition to its new diet, so continue breastfeeding
as long as you can.
After the first 4 to 6 months, your baby must also
get a share of the family foods. Give the baby one
type of food at a time until it learns to enjoy a variety
of foods. Start with small quantities and gradually
increase them to suit its age and appetite. Feed the
babv frequently.
Your baby will grow well on foods like kichari,
dalia, da] mixed with rice or chapati, lightly cooked
fresh green leafy vegetables, half boiled eggs and
fish. Fresh fruits like papaya and banana along with
fresh orange, musami or lime juice are also good
for the growing baby.
Mash the food well to make it easy for the baby to
swallow and digest. Add a little ghee, butter or oil.
This makes the food tastier amd gives extra
energy.
Soft foods should be given between breastfeeds.
Encourage the baby to feed itself with its fingers.
This is part of its growing and learning experience.
By one year, your baby is ready to eat the food you
prepare for the rest of the family.
29.
Should a breastfed baby also -be given extra
vitamins and juices? At what age should these
be given?
As long as the nursing mother is healthy and eats
enough of a variety of foods, there is no need to give
extra vitamins and juices to a breastfed baby for the
first 4 to 6 months of life. Breast milk will give the
baby all that it needs during this period.
Once the baby is 4 to 6 months old, its growing
8
Most mothers know the importance of hygiene. But
often a busy mother may overlook some details of
cleanliness. Can any mother afford to take this risk?
The hidden dangers—germs that you cannot seecan lead to illnesses in the family. A baby is more
likely to fall ill. You need to be extra careful if there
is a baby' at home.
Keep your home and surroundings clean. Germs
breed in dirt and contaminated food and water,
causing diarrhoea, and spreading diseases like
cholera, dysentry and gastroenteritis. Drinking
water must be strained through a clean cloth,
boiled and cooled. Store this water in a clean
covered container. Give your baby food which is
freshly prepared. Wash your hands before you
cook the meal or feed the baby. Keep utensils clean.
Wash diem well before and after use, and rinse
under running water.
JI. Are special baby foods available in the
market better than soft foods prepared at
home?
Special foods for babies available in the market are
based on a mixture of powdered milk with some
carbohydrates like wheat and rice. These foods
which are cereal and milk based are expensive. On
the other hand, a wise mother can provide her
growing baby with all the nourishment it needs
with the same things she uses to make the family
meal. Instead of spending large sums of money on
tins of baby foods, she can buy good wholesome
food for the entire family, including the baby. Soft
foods prepared at home give the baby a better
variety of foods, in addition to providing all the
nourishment it needs.
J2. Should I give soft foods before or after a breast
feed?
Soft foods should be given between breastfeeds,
preferably a couple of hours after a breastfeed. This
is advised because a baby will not make an extra
effort to eat soft foods when it is very hungry. This is
because suckling the mother's breast comes naturally
to a baby, whereas it has to learn to eat soft foods. A
hungry baby will be less interested in eating soft
foods on an empty stomach. Having had a breast
feed a couple of hours earlier, the baby will not be
too hungry when offered soft food and may show
more interest in this food than otherwise.
On the other hand, if you offer the breast im
mediately after it has been fed soft food, the baby
will not suckle the mother’s breast strongly since it
is not hungry at that moment. When the baby fails
to suckle strongly, it will not stimulate the breasts to
produce .more milk. Eventually the flow of milk
may reduce. Therefore, breastfeed your baby and
offer it soft foods a couple of hours later. Give the
next breastfeed a couple of hours after its last meal
of soft ioods. In this manner the baby will continue
to get the double benefits of its mother’s milk as
well as soft foods.
33.
Should a mother continue soft foods when the
baby is ill?
It is incorrect to stop feeding a baby when it is ill. in
fact the baby needs nourishment even more so
to recover from its illness. Food will give it the
strength to fight other illnesses which can set in
when the body is already weak.
Soft foods like kichari, dalia, rice or chapati mixed
with lightly cooked dal and vegetables will not harm
the babv. Sometimes when the baby is ill, it does
not feel hungry or may prefer to eat food other than
what it normally eats. While recovering from its
illness, the baby’s appetite will improve. Give the
baby slightly more than what it normally eats
because it needs additional nourishment to regain
its health.
34.
Why does my baby have diarrhoea while teething?
Is it because it is teething or thefact that I have
started giving it soft foods?
Often mothers tend to associate teething with
diarrhoea. This is incorrect. Diarrhoea occurs
when the baby eats contaminated food or drinks
water which is contaminated. Moreover when a
babv is teething, it tends to pick up things lying
around- the house and chew on it. These objects
can carry germs into its body and cause diarrhoea.
If you prepare soft foods hygienically, there is no
reason why the baby should have diarrhoea.
Introducing soft foods will not cause diarrhoea, as
long as they are well prepared. Wash your hands
before you make the meal or feed the baby. Use
fresh food. Use clean drinking water. Keep the
utensils clean. These precautions will help to
prevent diarrhoea.
35.
What is diarrhoea?
Diarrhoea is not a single disease. It is a symptom
that accompanies intestinal disorders. When a baby
has diarrhoea, it passes frequent watery stools
which may be foul smelling. Diarrhoea causes loss
of vital body fluids and salts. In somes cases, the
stools may also have blood and mucus.
36.
Is diarrhoea. dangerous?
Yes, diarrhoea can be dangerous especially for
babies and young children below two years. If you
fail to replace the fluids and salts that a baby loses
during diarrhoea, it can lead to a dangerous
situation called ‘dehydration’. Remember pro
longed diarrhoea can lead to dehydration and even
death. Do not take diarrhoea lightly. Unfortunately
some mothers think diarrhoea is not serious. This is
not true. Diarrhoea can become very serious if you
neglect it.
37.
Is it true that breastfed babies have less chance
of getting diarrhoea?
Yes, it .is true that babies who are breastfed
exclusively rarely have diarrhoea. Breast milk is not
only free of germs but also helps to prevent the
growth of those germs that cause diarrhoea. It has
been found that bottle fed babies have diarrhoea
six times more often than breastfed babies. This is
because the feed is not prepared hygienically. For
a bottle feed to be safe, you need to take many pre
cautions, like sterilizing the feeding botde and
nipple and boiling the water to make the feed.
Breastfeeding takes care of all this trouble. Breast
milk is the safest and most hygienic way to feed
your baby. Breastfeed as long as you can, even
when the baby has diarrhoea. Breast milk will give
the baby all the nourishment it needs to recover,
besides being easier for the baby to digest. In
9
addition, antibodies in your milk will protect the
baby from other illness which can set in when the
baby is already weak from diarrhoea.
38.
What should I do when my baby has diar
rhoea?
Give the home prepared salt and sugar solution or
the ORS solution every time it passes a water stool.
Continue giving this solution until it passes normal
stools. Some mothers simply stop feeding their
babies during diarrhoea. This is not good for the
baby for it needs nourishment. Give the baby
lightly prepared foods like kichri, dalia or rice and
curd.
There is a simple and inexpensive treatment that
every parent can administer at home. Start the
treatment at the first signs of diarrhoea.
41.
In a glassful of boiled and cooled water, add a pinch
of salt (% teaspoon). Make sure this solution is not
saltier dian your tears. Then add two teaspoons of
sugar or ‘gur’ and dissolve it well. The baby may
refuse to drink this solution, but insist on giving the
solution frequently in small quantities.
Diarrhoea is caused by germs which breed in
contaminated food and water, dust and unsanitary
surroundings. These germs enter the baby’s body
through contaminated food or water.
It is important that the baby drinks a glassful of this
solution every time it passes a watery stool. This is
approximately the amount of liquid it loses every'
time it passes a watery stool. So make sure that you
replace die fluids it has lost. Continue giving this
solution until the babv stops passing watery stools.
Plain water which is boiled and cooled, rice kanji or
coconut water can also be given in addition to the
salt and sugar solution. Remember to continue
breastfeeding and normal feeding during diar
rhoea. If the baby’s condition doesn’t improve
within two days, contact your doctor immediately.
39.
What is ORS?
ORS stands for oral rehydration salts. These salts
are specially prepared to deal with the loss of vital
salts from the body. Mixed with boiled and cooled
water, this ORS solution becomes a good rehydra
tion fluid. They come in packets and are available at
a chemist. Follow the instructions on the packet to
make the solution.
diarrhoea?
There are simple measures that you can' take to
prevent diarrhoea. Keep your home and surroundings clean. Drinking water must be strained
through a clean cloth, then boiled and cooled.
Store this water in a clean covered container. Keep
your utensils clean. Wash them before and after use
and rinse under running water. Give your baby
freshly cooked food. Wash your hands before you
cook the meal or feed the baby. All clothes includ
ing undergarments and bed linen must be clean
and fresh. Finally continue to breastfeed your baby
as long as you can, even when the baby has
diarrhoea. Breast milk is the safest and most
hygienic way to feed your baby.
42.
Should I give tonics or special foods when the
baby has diarrhoea?
You don’t have to give a tonic or any special kind of
food when the baby has diarrhoea. Just make sure
that it drinks plenty of liquids and eats well when it
has diarrhoea. When the baby has diarrhoea, you
need to replace the fluids.it loses. It also needs
good nourishment to regain its strength both to
recover and to fight against other illnesses which
can set in when it is already weak.
10
Would a breastfed baby catch a cold ifthe mother
drinks cold water?
No, this is not true. Breast milk comes at the right
temperature to suit the baby, irrespective of the
cold or hot drinks the mother consumes.
43.
40.
What should I do to prevent my babyfrom getting
Since breast milk contains antibodies, does this
mean that a breastfed baby does not require
immunization against common childhood
diseases?
Although antibodies present in the mother’s milk
do give immunities to some common childhood
diseases, every baby should be immunized
regularly to completely eliminate the risk of these
diseases. Table 1 gives the immunization schedule.
Remember that immunization is effective only
when a regular and complete dose is given. The
w
baby should not be ill at die time of immunization.
Breastmilk contains mother’s natural immunities to
protect the babv against illness. Breastfeed your
baby as long as vou can. In addition follow the
immunization schedule to completely eliminate
die risk of common childhood diseases like tuber
culosis, diphtheria, whooping cough, tetanus,
poliomyelitis and measles.
TABLE 1 IMMUNIZATION SCHEDULE
WHAT
WHY
3-9 months
BCG vaccine
protect against tuberculosis
3-9 months
3 doses of DPT and Polio vaccine protect against diphtheria, whooping
cough, tetanus & poliomyelitis
at intervals of 4-6 weeks each
9-12 months
Measles vaccine
1‘.-2 years
1st booster for DPT and Polio
5-6 years
DT booster
WHEN
!
protect against measles
protect against diphtheria & tetanus
UNITED NATIONS CHILDREN'S FUND
73 LODI ESTATE, NEW DELHI - 110003
GIVE YOUR BABY THE BEST START
IN LIFE
1.
Today I learnt that I am pregnant. What should I know about
care during pregnancy?
Welcome to the wonderful world of motherhood. The next few
months will be filled with much joy, hope and excitement as you and
your family await the arrival of the new born. Naturally you want only
the best for your baby. Looking after yourself is important not only
for your own sake, but also for your growing baby and family as well.
While you should not overwork yourself, it is good to keep up
with your normal activities. This will keep your muscles toned up
thereby helping you to have an easy delivery. A daily walk will also
help to keep you fit. You should however, avoid lifting anything
heavy as this can lead to a miscarriage.
You may feel more tired than usual, especially during the first and
last three months of pregnancy. This is due to the gain in weight and
other changes in your body. Rest for an hour in the afternoon with
your feet up on a pillow.
Regular visits to your doctor or the ante natal clinic are impor
tant. These medical check-ups will help the doctor decide if your
baby is growing well. Should a problem arise, help can be given at an
early stage. You can also use this opportunity to ask your doctor any
question that you may have.
Around the sixth and eighth months, your doctor will give you
two injections of tetanus toxide to avoid any possibility of tetanus
during childbirth. Tetanus can be harmful both for you and the baby.
To avoid complications during childbirth, it is advisable to have a
doctor or a trained midwife (dai) help you with the delivery.
Finally, relax and enjoy your pregnancy as you look forward to
the birth of your baby.
2.
What should I eat during pregnancy?
What you eat during pregnancy will make a big difference both to
your baby’s and your health. You need to eat sensibly to maintain
your health, to provide enough nourishment for the developing baby
and to prepare for breastfeeding.
Eating sensibly means eating a well balanced diet and eating a
little extra of everything that you normally eat. Eating well does not
mean eating expensive foods. You do not have to spend too much
extra on your meals.
During pregnancy your baby will take a great deal of iron, calcium
and other foods from your body. You therefore need to eat a little
extra both to meet the baby’s needs and to replace the nourishment
that the baby is taking from your body.
A well balanced diet should include foods from the three major
food groups:
(a) energy giving foods;
(b) body building foods;
(c) protective foods.
You should include one or two foods from each of the three groups in
your meals.
Foods that give energy include wheat, rice, millet, bajra, maize,
potatoes, sugar and jaggery, fats and oils. Body building foods
include dais, peas, beans, nuts such as groundnuts, milk, meat, fish
and eggs. Foods that provide protection include vegetables and
2
fruits such as spinach, methi, mustard leaves, mint (pudina), corriander, carrots, pumpkin, papaya, mangoes, bananas and oranges.
These protective foods are rich in iron, calcium, vitamins and miner
als and will protect your baby against deficiency diseases such as
anaemia, rickets, vitamin A and B deficiencies. Together, foods from
these three groups will provide ail the nourishment that you and your
baby need. (Illustration 1)
III 1: Pregnant and nursing mothers should eat some foods from each of the three
foods groups with each meal.
3.
What should I avoid during pregnancy?
Doctors recommend that pregnant women should not take any
medicines without the advice of a competent doctor as certain
medicines can harm the growing baby. This includes all kinds of pills,
tablets, cough mixtures, headache remedies and other medicines.
Avoid lifting anything heavy as this can lead to a miscarriage.
Contact your doctor immediately if there is any bleeding. Often
resting for a few days will help you continue with your normal
pregnancy.
3
gland which is lined with milk producing cells and it is here that the
milk is made. (Illustration 2)
111. 2: Cross section of the human breast
Around each milk gland is a network of muscle cells which can
contract, thereby squeezing the milk gland to force milk from the
milk cells into the duct. The main duct from each section widens as it
comes under the areola and is capable of widening even more as it
fills with milk.
While your body is capable of making more than enough milk for
your baby’s need, your baby has a vital role in the process of making
milk. The tip of your nipple has certain nerve endings. When your
baby suckles the nipple and areola, it stimulates these nerves. The
nerves in turn, carry a message to the pituitary gland in your brain to
release a hormone called ‘prolactin’ into the blood. The blood carries
prolactin to the milk producing cells in your breast. This hormone
then tells the milk gland to make milk. The more the breasts are
stimulated by suckling, the more hormone is released, and the more
milk is made. (Illustrations)
8
You can be confident that your milk need not dry up, but will be
adequate for your growing baby’s need, as long as you allow it to
suckle frequently.
8.
How is milk stored in the breast?
As explained in the answer to question 7, the milk glands in your
breast are connected to a system of milk ducts which lead to the
nipple. These milk ducts widen as they come under the areola. These
ducts can widen even more to hold milk. This means that under the
areola there are about twenty reservoirs which can store milk ready
for the baby at the beginning of each feed. (Illustration 2)
The milk collects in these reservoirs rather than dripping out
from the breast as a result of certain muscles in the nipple and under
the areola which act as a sphincter to hold back the milk from flowing
out. These muscles relax when the baby suckles or if you express the
milk with your hand. The milk filled in the reservoir can also come out
by expressing milk manually. Read the answer to question 41 for
more information on hand expressing.
9.
How does the baby get the milk from the breast?
There are two factors responsible for getting the milk stored in
your breast to the baby. One is the ‘let-down’ reflex, and the other is
the ‘law of supply and demand’.
The ‘let-down’ reflex works with the stimulation of the nipples
and areola when your baby suckles. This is the same stimulus that
causes the release of prolactin, as explained in question 7. In addition
to causing the release of the hormone prolactin, the stimulation of
the nerves around the nipple and areola carry another message to
the pituitary gland to release a second hormone ‘oxytocin’ into the
blood. Oxytocin is carried in the blood to the breast and makes the
muscles around the milk glands squeeze milk into the milk ducts.
This cycle of suckling-nerve message to the pituitary-oxytocin
release-contraction of muscle cells with the release of milk into the
ducts is called the ‘let-down’ reflex. (Illustration 3)
The reason that many women fail to breastfeed successfully, is
not because there isn’t enough milk, but because their ‘let-down’
9
Ill 3: The milk production and ejection reflexes.
reflex is faulty. This reflex is delicately balanced in the early weeks
after childbirth when external factors can prevent it from working
well.
The time taken for the reflex to work varies from woman to
woman and in the case of a woman, could vary from day to day
depending on her surroundings, her emotional state of mind and
other factors. Strong emotions such as fear, worry, anxiety, embar
rassment and fatigue can also prevent its action.
A mother who is unaware of how this reflex works and the factors
that affect it, could well find herself saying-I don’t have enough milk
so I’ll have to bottle feed. In actual fact, the milk is all there, stored in
her breast waiting for the ‘let-down’ reflex to start. Once you under
stand this, you will not panic while suckling your baby. Relax, let your
baby suckle away and soon the milk will flow out.
Nipple stimulation is not the only way in which the milk can be let
down. This reflex is easily conditioned by other factors. The sight or
sound of your baby (or even some other baby) can suddenly let down
your milk, particularly if you haven’t fed for sometime. Other women
find that as they prepare to breastfeed, their let-down reflex works
10
before suckling actually begins, simply because the reflex has been
conditioned by their routine. This is a good thing because then the
baby does not have to wait for the milk to flow.
In addition to causing the let-down reflex, oxytocin has other
effects. The uterus or womb is sensitive to oxytocin and contracts
when there is an increased level in the blood. These contractions
cause ‘after pain’ that some mothers feel when breastfeeding in the
first few days after childbirth. Also while milk is being let-down, the
breasts may tingle and feel tense. This is usually a pleasant feeling for
the mother. In the early days of feeding, it is easy to know when the
reflex is working because of the sensation in the breasts, leaking of
milk, the warmth of the breast skin and the contraction of the womb.
However, some mothers may have none of these sensations, and
yet have a very good let-down reflex.
All the time a baby is feeding, the nipple and the areola are
stimulated, so causing the pituitary gland to release prolactin and
oxytocin. Since prolactin controls milk production, the more suc
kling there is, the more prolactin will be produced, which in turn
produces more milk. Also the more often the baby suckles, the more
reliable the let-down reflex becomes. This is the basis of the second
factor involved in bringing milk to the baby-the law of supply and
demand. The more feeds your baby ‘asks’ for and gets in a day, the
greater the supply of milk there will be. This is the reason why babies
who are fed whenever they ‘demanded’ a feed gained weight faster
than those who were fed according to fixed time, showing that their
mothers were producing more milk by feeding more often. For more
information on demand feeding, read the answer to question 16.
10.
During pregnancy what should I do to prepare my breasts and
nipples for breastfeeding?
In the first few months of pregnancy, your breasts and nipples
may feel tender and sore to the touch. This feeling will soon go away.
A few precautions and some simple excercises, particularly in the
last three months of pregnancy will prepare your breasts and nipples
for breastfeeding, increase their suppleness, accustom you to han
dling your breasts and expressing milk when the baby arrives.
While taking a bath every morning, wash the breasts and nipples
11
with plain water. As soap dries the skin, you should avoid using it
while washing your breasts and nipples. Dryness can lead to cracked
nipples which can be painful. Also avoid scrubbing the breast with a
rough towel or a brush. This can damage the nipple and remove
natural oils. These oils keep the skin of the areola and nipple supple
and also kill surface bacteria on the skin. If you wash with soap, then
the skin may get sore when the baby starts suckling.
During the last three months of pregnancy repeat the following
excercises to make your nipples supple thereby helping the baby to
suckle. Gently pull out your nipples. Hold the nipple at the base
where it joins the areola and roll it gently between the thumb and
fore-finger. Repeat this excercise several times with each nipple.
(Illustration 4a) It should not cause pain although it may feel
uncomfortble at first. Gradually, increase the number of nipple
pullings and rolling excercise. In addition, massage your breast by
cupping with your hand and pressing your finger and thumb slightly
towards the chest wall. Circle your breast with this gentle massage
excercise. (Illustration 4b)
•
/
I ib»
4 (<*»
111. 4a and 4b: During pregnancy preparing breasts and nipples to breastfeed.
12
I
11.
What are inuerted nipples and how should I deal with them?
Nipples that don’t stand out when pinched are called inverted or
flat nipples. Try this test: Squeeze or pinch the areola between your
fingers. If the nipple stands out, even a little, it is not inverted. If the
nipple however, shrinks back when pinched, the nipple could be
inverted. (Illustration 5)
Fortunately most women have normal nipples. Regular visits to
the doctor during pregnancy will help the doctor deal with this
problem should it arise, and start treatment as soon as possible.
Inverted nipples can make it difficult for the baby to hold while
suckling. Therefore, it is important that your doctor examines your
breasts and nipples during the ante-natal visits.
12.
Will I be able to breastfeed successfully?
A common reason mothers give for stopping breastfeeding is the
fear that they do not have enough milk, and so, they introduce their
babies to bottlefeeds in the first few days after birth.
Research shows that in practice, almost every mother can
breastfeed successfully. Rarely, is there any physical reason for
being unable to feed the baby naturally. The most important thing to
remember is that the mother must want to breastfeed, have confi
dence in her ability to breastfeed and must not lose hope.
13
Read the answer to question 9 which deals with the let-down
reflex and explains how a faulty reflex will prevent the milk in the
mother’s breast from flowing into the baby's mouth.
Further, studies have shown that women who want to breastfeed
actually produce more milk than those who don’t want to or are
indifferent about breastfeeding their babies. Many women fail to
breastfeed successfully, even though they want to, because they
believe incorrectly, that they do not have enough milk for their
baby’s need. The truth is that almost all mothers are capable of
producing more than enough milk for their baby’s need.
13.
How soon after birth should the baby be put to the breast?
Breastfeeding should start soon after birth, preferably within an
hour. Many doctors today advice that the newborn should start
suckling right away within minutes of the birth. This serves two
purposes. After the trauma of childbirth, close contact with the
mother's body makes the newborn feel warm and secure. Second,
the earlier the baby starts suckling, the sooner it gets colostrum or
the first milk from its mother. Research has also shown that the
sooner the baby starts suckling, the sooner and better the milk will
flow.
You should discuss this with your doctor, and insist that your
baby is kept with you soon after childbirth.
14.
What is colostrum? Is it important for my baby?
For the first day or two, the small amount of milk that flows from
the breast is called colostrum. This milk is extremely nourishing for
the newborn. Though small in amount, colostrum is enough to meet
the limited needs of the baby in its first 2 or 3 days of life. What makes
colostrum even more special is the fact that it is extremely rich in
antibodies produced by the mother. These antibodies protect the
newborn against some diseases and infections at a time when the
baby is particularly vulnerable. Later milk also contains these antibo
dies, but not as much as first milk. In addition, colostrum has certain
properties that prevent allergic diseases like asthma and eczema
which are common in bottlefed babies.
14
Traditionally in many Indian homes, colostrum is thrown away
because people believe incorrectly that this milk is stale. Today
medical research has taught us that in actual fact colostrum is
extremely valuable to the newborn. Throwing away colostrum
deprives the newborn of the best possible nourishment available, as
well as the protection that it offers against infection. Rich in proteins,
minerals and vitamins, colostrum is just what the newborn needs
soon after its birth and is easy on its delicate digestion. Indeed,
according to many doctors, colostrum has life long health preserving
benefits.
15.
Should the baby be kept with the mother or in a separate room
after birth?
Every mother should insist that her newborn is kept with her in
the same room, no matter where she is: at home, hospital or the
nursing home. This is called ‘rooming in’. (Illustration 6)
111. 6: ‘Rooming in' or keeping baby with the mother in the same room, soon after
birth.
15
Many hospitals and nursing homes keep the newborn separately
for the first few days. Although a nurse will bring the baby to the
mother, tn the course of the day she may also give the baby an
occasional ‘top’ or bottle feed. Even a single bottle feed can disrupt
the formation of the normal suckling habit and can reduce the
mother’s milk supply.
This happens because suckling the mother’s nipple requires
greater effort on the baby’s part. Nature intended it to be this way.
This extra effort by the baby helps to stimulate the breasts to start
and increase the flow of milk. On the other hand, suckling the feeding
bottle is much easier. If your baby gets used to suckling from a
feeding bottle, it will not exert much pressure while suckling your
breast. If the baby doesn’t suckle hard enough, it will not stimulate
the breasts enough to produce more milk. This can reduce the flow
of milk from your breasts. Therefore it is vital that every mother
insists that her baby is kept with her soon after birth and is exclu
sively breastfed. Not only would the baby get colostrum that flows
for the first day or two, but frequent suckling whenever the baby
cries for a feed will ensure a good flow of milk. Read the answer to
question 9 for more details on this.
16.
How often should a baby be breastfed in a day?
Babies usually cry when they are hungry. Put your baby to the
breast each time it cries for a feed. This demand feeding is a better
way to feed your baby than feeding at fixed times. For more informa
tion, read the answer to question 9.
Babies could also cry for some other reasons, such as if their
nappy is wet or if the clothes are too tight. Having checked that none
of these is the source of trouble, you should interpret the baby’s cry
as its demand to be breastfed.
Your baby is a special person, an individual unlike other babies.lt
is not just a hungry stomach to be filled at regular intervals. Once you
accept that the baby may ask for a feed at different times, depending
on when it is hungry, you are well on your way towards breastfeeding
successfully. If you worry each time it cries for a feed too soon, you
are more likely to lose your milk. This happens because worry can
interfere with the ‘let down’ of the milk from your breasts.
16
While some babies settle down to a routine ot demand feeding
after a few weeks, others don’t. So do not compare your baby with
other babies. Just breastfeed your baby whenever it cries for a feed.
As the baby grows it may ask for fewer feeds and may settle down
to a regular demand routine, every two or three or four hours.
Sometimes your baby may demand a feed more often than other
times. This could be for many reasons: the baby may be extra
hungry, growing rapidly, teething or is just upset. If the baby needs
extra feeds, your own milk supply will adjust to its needs if you let the
baby suckle as much as it wants to and whenever it demands a feed.
17.
How long should each breastfeed last?
Let your baby tell you how long it needs to suckle your breasts to
get its fill. A hungry baby will cry for milk. The old rule of 10 minutes
on each breast was created because that was roughly the average
time that a baby takes to feed. But each baby is different. So while
some babies take less than 10 minutes to a side to get their fill, others
may take longer.
During the first few months, you may find that your baby wants a
feed very frequently. This is not unusual and is the baby’s way of
increasing your milk supply to suit its growing needs. People may tell
you that a baby gets all the milk that it needs in the first few minutes at
each breast. But all babies are not alike. A lot will depend on how
vigorously the baby suckles, the strength of your ‘let-down’ reflex
and the time taken for the ‘let-down’ or start of the milk flow.
Remember that some babies enjoy suckling even if they have had
their fill. There is no reason to stop this unless you have some other
work to do, or if you have sore nipples. This ‘comfort suckling’ is
considered by many experts to be an important factor in the child’s
emotional development, and should be encouraged.
When your baby has had its fill on one breast, in other words,
when it loses interest in feeding, change it to the other side. Let the
baby continue feeding on the other breast as long as it wants to.
There are times when the baby will feel less hungry, is sleepy or just
tired and may not want to suckle very long. Don’t worry about this,
and don’t force the baby to feed. Just offer your breast after a little
while.
17
18.
How will I know if my baby is getting enough milk?
It is true that when you breastfeed you cannot actually see how
much milk the baby drinks. However, if your baby sleeps well, is
healthy, active and playful when awake and gains weight steadily
each month, you can be sure that your baby is getting enough milk
for its nourishment and growth.
19.
How can 1 increase the flow of milk in my breast?
The baby’s suckling is the best way to start and increase the flow
of milk in your breasts, and the sooner the baby is put to the breast
the sooner and better will be the flow of milk. Let the baby suckle as
frequently as possible because the more often a baby suckles the
breast, the better it stimulates the breast to produce more milk. This
is nature’s secret to start and increase the flow of milk to meet your
baby’s growing needs.
Sometimes emotions like embarrassment, tension or fatigue can
also interfere with the let down of the milk. A mother should there
fore relax and sit confortably when she feeds her baby.
When the baby suckles, it stimulates two hormones which are
released into the mother’s bloodstream. One of these hormones
stimulates a strong flow of blood through the breasts and activates
the milk making tissue. The other hormone causes the breasts to
push out or ‘let-down’ the milk from the breasts. This is generally felt
as a ‘pins and needless’ sensation or a full feeling in the breasts. If the
milk doesn’t ‘let-down’ your baby will not get all the milk that is
available in the breasts. Fortunately nature has ensured that when
the baby suckles frequently, the ‘let down’ reflex works well. For
more information, read the answer to question 9.
20.
What should I eat to increase the flow of milk in my breasts? Are
there medicines to increase this flow?
There are no special foods or medicines to improve the quality
and quantity of breastmilk. To breastfeed successfully and to main
tain her own health, a nursing mother should eat slightly more of the
food she normally eats. There is no need to eat anything special. An
extra helping of rice or chapati, dal, green leafy vegetables and fresh
18
fruits will give the nursing mother all the nourishment she needs to
produce enough milk for her baby and to maintain her own health.
Eggs, fish and meat are also good. What is important is to eat slightly
more of everything that she normally eats, rather than eating any
thing special while nursing her baby. (Illustration 1)
Finally be assured, you can increase your milk supply. Nature has
made sure that when the baby suckles the breast frequently, the milk
will flow well. All you need is the confidence in your natural ability to
breastfeed successfully. Eat and rest well.
These early months can be a challenge, demanding much
patience and determination on your part. So do relax and enjoy your
baby. Remember that not only is your baby receiving the best food
available, but also both your baby and you are building a happy and
secure relationship during this period.
21.
How should I hold the baby while breastfeeding?
There is no ideal position to hold the baby while breastfeeding.
The main thing is make yourself comfortable because you will be in
that position for some time, and try to make the baby comfortable.
Pain and discomfort can reduce the ‘let-down’ of milk.
Support the baby’s weight with a pillow on your lap. Another
pillow under the arm supporting the baby will also help. If you are
sitting, it is easier to feed if you sit upright and lean slightly forward.
Hold the baby with its chest and stomach against you, so that it
doesn’t have to turn its head around and can feed comfortably.
(Illustration 7) Some babies like to have something to hold on the
while feeding-give the baby your finger to hold onto. At night, lie on
your side and breastfeed the baby. (Illustration 8)
Don’t push the baby’s mouth onto your nipple. This could
frighten the baby. Instead, stroke the side of its mouth with your
nipple. If your breast is very full, you may have to hold it back so that
the baby’s nose is not smothered. But don’t bother to hold your
nipple or breast once the baby starts suckling. Expressing a little milk
from a full breast will soften it enough to enable the baby to hold on.
When breastfeeding, part of the areola (the dark area around the
nipple) should go into the baby’s mouth as the milk reservoirs are
under the areola and need to be emptied by the baby’s suckling.
19
Ill: Common positions to breastfeed.
20
I
(Illustration 9) If only the nipple goes into the baby’s mouth, not
enough milk will flow out. The baby would have to suckle extra hard
and this could lead to sore nipples. If you have an extra large areola,
hold it between the finger and thumb and squeeze them together.
This will make the areola flatter and easier for the baby to take in its
mouth.
You may notice at times your baby stops suckling and looks
around. This happens because the ‘let-down’ causes the milk to be
spurted in an uneven flow. Several spurts of milk come out, and then
there is a short pause before the milk flows again. Your baby is
adapting to the flow of your milk and its breathing pattern is also
altered to fit in with this drinking pattern.
III. 9: The correct position: baby takes both the nipple and areola into its mouth.
The position of the baby's head allows it to breathe and suckle at the same time.
22.
How can I tell when the baby has had enough milk?
Babies often show they have had enough milk simply by falling
asleep. But before they go to sleep, they may unclench their fists,
21
smile, refuse to drink anymore or just arch their back. Don't force
the baby to feed any more if it doesn’t want to. Learn to accept your
baby’s judgement about when and how much it wants to feed.
23.
Can a woman with small breasts produce enough milk9
Some women with small breasts worry about their capacity to
produce enough milk for their baby’s need. The size of the breasts
have no relation to their capacity to produce milk. Women with small
breasts can and do produce more than enough milk for their babies.
Worry will only reduce the flow of milk. What is important is not the
size of your breasts, but allowing your baby to suckle frequently.
Frequent suckling will stimulate your breasts to produce more milk.
This is the secret to successful breastfeeding.
24.
Can a mother breastfeed while having her periods?
There is no reason why a mother should not breastfeed during
her periods, since this will not harm her or the baby. Some mothers
say that their babies are temperamental when they have their peri
ods. This is quite likely due to the mother’s own menstrual tension
being communicated to the baby. There is no difference in the
mother’s milk during her periods.
25.
Can a mother breastfeed while she is ill?
Yes, a mother can continue breastfeeding her baby even while
she is ill, without harming the baby. In most cases, the baby will get
the protection against the mother’s illness from the antibodies pres
ent in breastmilk.
Most medicines taken for illnesses do pass into the breastmilk
but in such small quantities, that they are unlikely to harm your baby.
Consult a doctor who will prescribe medicines which are less likely to
harm the baby. The doctor will also advice the mother to continue
breastfeeding.
However, if the mother has high temperature, jaundice or septacaemia, the doctor will advice her to discontinue breastfeeding until
she recovers. A mother who has been advised to stop breastfeeding
during an illness should however, express her milk regularly and
22
throw it away until she has fully recovered from the illness. This
practice will ensure that her flow of milk is not reduced. On recovery
she should resume breastfeeding the baby.
During the period when she has been advised to discontinue
breastfeeding, the mother can give the baby fresh cow, goat or
buffalo milk or even milk from the local dairy centre. Do not dilute
this milk. Do not use a feeding bottle to feed your baby. Instead, use a
clean spoon and cup.
Generally speaking in most common illnesses, a mother can
continue breastfeeding without any ill effects on the baby.
26.
Should a baby be breastfed even when it is ill?
Yes, your baby can certainly be breastfed even when it is ill. In
fact it is very important that you continue breastfeeding while the
baby is ill because your milk will provide the baby with antibodies to
protect it from other illnesses which can set in when it is already
weak. Breastmilk will also give the baby the nourishment and
strength to recover from its illness.
Do not stop breastfeeding when the baby is ill, unless your doctor
advises you to stop. But this is rare. Unless your baby is so ill that it is
not allowed milk, the baby will do better drinking breastmilk than any
other milk. Breastmilk is much easier for the baby to digest. Besides,
the baby will recover faster from vomiting, diarrhoea and dysentry if
it is given your milk.
27.
Can a mother breastfeed even when she is pregnant?
Yes, a mother can certainly continue to breastfeed her baby all
through her pregnancy without any ill effects on either the breastfed
baby, the baby in the womb or herself. However, a pregnant woman
who is breastfeeding her earlier child should eat slightly more for the
sake of the breastfed baby and herself as well as for the baby growing
in her womb. All three require good nourishment during this period.
28.
Is it possible that breastmilk may not suit my baby?
Babies are rarely allergic to breastmilk. Nothing could be more
suitable than what nature intended to feed your baby. In fact animal
23
milk and powder milk are unnatural for the baby’s system. It has
been found that bottle fed babies are more likely to suffer allergies
like asthma and eczema. Bottle fed babies are also more prone to
diarrhoea and gastro-enteritis. Do breastfeed your baby. Breastmilk
is the safest and most nourishing food available for the baby.
29.
How should I take the baby off the breast after it has had its
feed?
While some babies let the nipple go after they have had their fill,
others have to be gently removed from the breast. Never pull the
baby’s mouth away from your breast while it is still feeding. Even
when the baby has finished feeding, but is still holding the nipple, do
not pull it off. This pulling action while the baby is holding the nipple in
its mouth can damage the nipple and areola apart from frightening
the baby.
Instead, with your fingers press the breast away from the corner
of the baby’s mouth, or gently pull back on its cheek near the corner
of its mouth or press down on its chin. The baby will break loose
easily and painlessly from the nipple.
Some babies like to suckle even after they have had their fill. This
is called ‘comfort suckling’. According to doctors this should be
encouraged because it helps the emotional development of the baby.
For more information about comfort suckling, read the answer to
question 17.
30.
Why does a baby need to be burped after a feed? How should I
hold the baby while burping?
While feeding, a baby can sometimes swallow air that needs to be
expelled or burped for the baby to feel comfortable. A bottlefed baby
usually swallows in air more often, because of the way in which milk
flows from an artificial nipple. Swallowing air is not common among
breastfed babies. If the baby however, feels uncomfortable, do burp
it.
You can place your baby on your shoulder and gently pat its
back. A clean diaper or a piece of cloth tossed over the shoulder will
absorb any milk that comes up. Holding up the baby in an upright
24
position will bring up most air bubbles in an easy and relaxed way.
Another method is to raise the baby slowly, to a sitting position.
When the baby is very small, take care to support its head and back
and hold the baby in this position for only a few moments. Some
mothers rest the baby, tummy down, across their knees and rub or
pat its back. (Illustration 10)
In the early weeks try burping the baby when you switch from one
breast to the other during a feed, and again when the feed is over. If
there is no burp after a few moments, you can forget the idea unless
of course, the baby is fussy.
Anytime your baby burps especially loud and heartily, see if it
wants a little more milk. The big air bubble may have made it feel full
when it really wasn’t. But if baby falls asleep at the breast while
suckling, it is better not to disturb it with the burping routine. Lay it
down carefully, either on its side or stomach, but not on its back.
When it is lying on its side, the milk that the baby may spit out, will
run out of its mouth without disturbing the baby.
Little babies also seem prone to hiccups after a feed. Don’t worry
about them, they are perfectly normal.
Ill 10: Two common positions to burp the baby after a feed
25
31.
What causes colic? How should I deal with it?
When a baby has long periods of hard crying and seems to be
uncomfortable for no apparent reason that you or your doctor can
discover, it is often said to be colicky.
“Colic” means loud persistent screaming for no apparent reason.
Doctors still seem to know little about the cause of this kind of crying.
Perhaps a good guess is that some babies have more delicate diges
tive system than others, and this factor combined with tension and
stress from the outside is the likely cause of colic.
Calm and gentle handling by the mother is essential. Your colicky
baby may also have an almost constant need to suck and many
doctors believe that frequent small feedings are easier for the baby to
handle than fewer larger feedings.
When the baby is in distress with colic, you should hold the baby
a great deal. Your gentle touch and soothing voice are important
reassurance to your little one that you are nearby, ready to tend to its
needs.
Colic usually subsides after the baby is three months old. It is
thought that by this time, it has matured enough to be able to cope
somewhat better with whatever is bothering it.
32.
What are the common problems associated with breasts and
nipples after childbirth?
Sometimes with all the care in the world, a mother can face
problems with her breasts and nipples. Often the pain and discom
fort discourages her from continuing to breastfeed her baby and
makes her turn to the bottle instead.
If you happen to be one of these mothers, be assured that most of
these problems can be solved and that the pain can be stopped
without your having to put the baby off the breast, if you know what
to do.
Some of the common problems mothers face after childbirth
include sore and cracked nipples, blocked ducts, engorged breasts,
and breast abscess.
33.
I
Can you tell me more about sore nipples and their treatment?
Many breastfeeding women experience pain in their nipples par-
26
i'
ticularly during the first few weeks of breastfeeding. Often this pain
or soreness discourages some mothers to continue breastfeeding.
But there are ways to overcome this problem and prevent it happen
ing again. The nipple becomes red and swollen and sometimes tiny
leaks of blood appear on the skin. Pain is usually worse when the
baby starts suckling and fades after a few minutes.
Some mothers find that the baby’s suckling is painful at first
because the nipple has not stretched enough. This pain is felt more
where the nipple joins the areola. This is a temporary problem.
Hormonal changes in your body and the baby’s suckling soon break
down the adhesion^ which anchor the nipple to the breast. No
treatment is necessary although the nipple rolling excercise recom
mended in pregnancy may speed up the process.
Other mothers feel the pain because the baby’s position at the
breast is incorrect. This is the most common cause of sore nipples in
mothers of first born. While it is important to ensure that the baby
holds the areola rather than just the nipple, the angle of the baby’s
head and body is important too, as well as the (act that its body is
close to the mother’s. The baby can only feed easily if the closeness
of its chest to the mother’s makes it put its head up. A baby can feed
and bi^athe easily if its head is supported at this angle.
The common practice of holding its head against the breast
causes distress and may result in ‘fighting’ at the breast as the baby
struggles to reach the angle at which it can breathe and feed at the
same time. If baby is not being held close against its mother, the
nipple will tend to slip out as the baby pulls back, particularly if the
nipple is not yet fully protractile. To hold the nipple in, the baby
exerts suction on it, and this results in sore nipples.
Once the baby’s position is corrected the following suggestions
will help heal your sore nippies:
(a) give shorter and more frequent feeds;
(b) start feeding on the less painful breast;
(c) alternate your position for each feeding, as this will distribute the
pressure of suckling to different parts of the nipple;
(d) check to make sure that the baby has both the nipple and the
areola in its mouth rather than just the nipple alone;
(e) between feeds, expose your nipple to the air or wear a loose
blouse to allow air to circulate; this will keep the nipple dry;
27
(f) when nipples are dry, apply warm coconut oil;
(g) hand express a little milk before you start to feed; this will start
the milk flowing and will lubricate the nipple;
(h) if the pain is too severe, put a cold ice compress to soothe the
pain.
Consult your doctor for further advice.
Some mothers are discouraged by the pain and stop breastfeed
ing altogether. There is no need to do this. As explained earlier after
rhe first few minutes, when the milk lets down, the pain generally
subsides. Taking the baby off the breast after only two or three
minutes (before the let-down) makes the nipple worse; not better,
and frustrates the baby. Breastfeeding for ten minutes on each side,
as often as every two hours is actually easier on sore and tender
nipples than nursing less frequently. The breasts don’t get too full,
and the baby is not so hungry that it chews or suckles frantically on
the sore nipple.
34.
What causes cracked nipples and how should I treat them?
Cracks can appear on nipples that are sore and go untreated. An
opening or a crack appears on the face of the nipple or where the
nipple joins the areola. It can be very painful when the baby begins a
feed or even all through the feed, and may also bleed. Healing is often
slow, and may be further delayed if a thrush infection occurs. You
should see your doctor immediately and explain that you are keen to
breastfeed.
The best prevention and treatment for cracked nipples is to take
all steps for the treatment of sore nipples. If the crac k does not heal in
a few days, you may have to take the baby off the breast for a few
days. You can however, still hand express your milk to feed the baby.
After the crack heals, gradually resume feeding, starting twice daily
and continue to express milk between feeds.
35.
How do breasts become engorged? How should I treat them?
When milk' begins to flow in the first few days after birth, it is
important to ensure that your breasts are empited frequently by the
baby to prevent them becoming overfilled. If breasts are not emptied
frequently, milk collects in the ducts until the breasts become lumpy,
28
swollen, hard, tense, painful and hot. This is called engorgement.
The breast is liable to bruise, is shiny and pitted like orange peel. The
mother feels hot and shivery and may sweat profusely. She may also
feel thirsty and should drink plenty of water.
But this discomfort is only part of the problem. When breasts are
engorged, they also affect the milk producing cells in the milk glands.
This happens as a result of the pressure of milk that has collected in
the breast. If this problem is not treated soon, it can affect the ability
of the milk producing cells, so that your milk supply may dry up.
Failing to deal with engorged breasts is one of the common
reasons for the failure of milk supply particularly in the early days.
Yet this failure can be completely prevented, if you know what to do.
Mothers who say that their milk stopped flowing after a few days
could, in almost every case have breastfed well if only they had been
given better advice. Read the answers to questions 7-9 for more
information on how to manage breastfeeding in the early days. If you
follow this advice, it is unlikely that your breasts will become
engorged.
Here are some simple steps that you can take to cope with
engorged breasts should they occur:
(a) Feed your baby more often, and feed it as soon as your breasts
feel full, even if the baby has not demanded a feed.
(b) In case the baby refuses a feed, it is better to hand express the
milk in your full breasts. It is better to discard this milk than letting
your breasts get swollen with extra milk while the baby is between
feeds.
(c) Remember that the more often the breasts are emptied, the
better the milk will flow.
(d) Feed your baby for longer periods.
(e) If the breasts feel so tense that it is difficult for the baby to feed,
soften the areola before the feed by expressing the milk. A baby who
suckles on a tense areola will not grasp the nipple and areola into its
mouth properly. This can lead to sore nipples and will draw little milk.
This happens because the pain the baby causes to the mother by
chewing on a tense nipple will prevent the mother’s let-down reflex
from working normally.
(f) Relieve the tenderness and pain in your breasts with ice packs
and with cold compresses applied frequently to the breasts.
29
36.
Why does milk sometimes leak from the breast between feeds,
and how can I cope with it?
Breasts usually leak when the let-down reflex starts working
before the baby actually starts suckling. They can also leak if your
breasts are too full of milk or if you are feeling very warm.
Leaking means that your breasts are full and ready for your baby.
You should suckle your baby as this will relieve the breasts. If breasts
remain full for too long, it can lead to engorgement, especially in the
first few weeks.
Try not to express too much milk with your hands in an effort to
empty your breasts, as this will only stimulate your breasts to pro
duce more milk. Instead, suckle your baby whenever it demands a
feed rather than feeding at fixed intervals.
You can cope with leaking by using either breast pads or any soft
material such as a hanky or an old nappy tucked into your bra
What should a mother do about breastfeedins if she has had a
caesarian operation?
Except in rare cases, there is no reason why a woman who has
had a caesarian operation cannot breastfeed as successfully as the
woman who has had a normal delivery. However, after a caesarian
operation you are bound to be in pain. If you are determined to
breastfeed, then you would have to put your pain and discomfort
aside and insist that your baby be brought to you as soon as you are
awake. As a bonus, breastfeeding your baby will help to compensate
for some of the disappointment you may feel not having experienced
a normal childbirth.
Unlike a mother who has had a normal delivery, you will not be
able to breastfeed immediately after childbirth as you will be under
the effect of general anaesthesia. However, insist that your baby be
brought to you as soon as you are awake and kept with you. Also you
should insist that you do not want your baby to be bottle fed. Put the
baby to the breast whenever it cries for a feed, instead of feeding it at
fixed schedules. It is vital that you put the baby to the breast as soon
as you are awake, so that your baby is not deprived of colostrum.
Frequent suckling will stimulate your breasts to produce more milk.
In a day or so, your milk supply will settle down to suit your baby’s
need.
37.
30
At first you may face a problem deciding on a comfortable
position to breastfeed. Sitting up after a caesarian operation can be
painful. However, don’t let this problem put you off breastfeeding.
Lie on your side and let the baby suckle your breasts. After the baby
has had its fill on one sid<5,.ask someone to help you turn to the other
side and continue breastfeeding from the other breast.
Remember breast milk is the best and complete food for your
baby, besides being the safest and most hygienic. For your baby’s
sake, put your pain and discomfort aside and insist on breastfeeding
your baby as soon as you are awake. Do not let people discourage
you from breastfeeding. After all, as a mother, you would not like to
deprive your newborn of the best food available.
38.
What causes a blocked duct and what is its treatment?
If you notice a tender spot, redness, painful lump or swelling in
your breast, this could be a blocked milk duct. Frequently this arises
when the baby is positioned incorrectly at the breast.
Often a blocked or a plugged duct can also occur when the time
between breast feeds is prolonged because of hospital schedules or
when the baby sleeps through the night; with supplementary or ‘top’
feeds with bottled milk or over use of a pacifier. Another factor is the
constriction of an overly tight bra or the bottom band of a fastened
non-nursing bra which has been lifted over the breast for nursing.
Sometimes a plugged duct is caused by dried secretions covering
one of the nipple openings.
Check the baby’s position at the breast. The baby’s whole body
should face you and it should have most of the areola and nipple in its
mouth. Try changing the nursing position from time to time to
distribute the pressure on your breast, such as leaning over the baby
to suckle, sitting up or laying down.
Remove the dried milk on the nipple by soaking with plain warm
water. Take a warm shower, apply heat, hot wet packs or a healing
pad. Massage the area gently and try to nurse the baby or hand
express some milk after treating the area with warmth.
Suckle the baby on the affected side often and long enough to
keep the breast fairly empty. The more frequently you breastfeed, in
other words, the more often you empty the breast, the better, at
least, every hour or two.
31
Loosen clothes that are tight at the breast or discontinue wearing
your bra for a few days. Rest as much as you can.
A blocked duct will usually show improvement in twenty-four
hours, if the treatment described here is followed. But do rest for a
few days, as a blocked duct may lower your resistance and could lead
to a breast infection.
39.
What causes breast infection and how should I treat it?
If you notice the type of soreness described as a blocked duct in
the answer to question 38. accompanied by fever or flu like symptom
(feeling tired, bodyache and run down), you could have the beginning
of a breast infection. You need to see your doctor immediately.
It is best to start treating a breast infection as soon as possible.
Do remember that it is safe to continue breastfeeding on an infected
breast. Studies show that the baby is not harmed in any way by
suckling when the mother has a breast infection. Antibodies are
formed m the milk that protect the baby from the bacteria causing
the infection.
Moreover, sudden weaning off the breast is an emotional and
physical shock both to you and the baby, and breast engorgement
that generally follows sudden weaning, makes the infection worse.
Studies have also shown that continued breastfeeding during breast
infection helps clear the infection much more quickly.
Follow the treatment outlined for a blocked duct. Apply heat on
the breast, rest as much as you can and continue frequent suckling.
Many doctors have found that if this treatment is begun soon,
antibiotics may not be necessary.
40.
Can you tell me more about breast abscess?
On rare occasions, a breast infection can worsen and develop
into an abscess. If you catch the infection in time and treat it carefully
as explained in the answer to question 39, this rarely happens.
The doctor may decide to open the abscess and drain it surgi
cally. You may have to stop breastfeeding on the abscessed side for a
few days if the wound is near the nipple, but you should continue to
hand express the milk from that side to keep the breast empty and
promote healing. Do keep breastfeeding the baby on the other
breast.
41.
How do I express milk from my breast? How can I store this
milk? What is the best way to feed this milk to my baby?
Wash your hands before you express the milk. Cup the breast in
your hand with your fingers just back of the areola, thumb on top and
other fingers underneath, supporting the breast. Squeeze your fin
gers together rhythimically while pushing back towards the chest
wall. Rotate your hand around the breast in order to get at all the milk
ducts that spread out from the nipple in all directions. (Illustration 11(a))
After working on one side for a few moments, repeat the process
with the other breast, then work on each side once more. This
changing back and forth gives the milk a better chance to come down
the milk ducts. Hold a clean container just under the nipple with your
free hand to collect the milk (Illustration 11(b)). Before expressing this
milk, do remember to boil the container and the lid in water for 10
minutes to kill germs. Allow the container & lid to cool a little in this
water. Remove them both without touching the inside surface and
store carefully preferably in a refrigerator. Use this container and lid
which has been previously boiled and allowed to cool, to collect
expressed milk. This precaution will prevent your expressed milk
from getting contaminated.
Ill: 11(a) and 11(b). Hand expressing and collecting mothers milk.
33
Remember that expressed milk will separate into two layers. This
is normal. Some mothers have unnecessarily discarded this milk
thinking something was wrong with it.
Expressed milk can be stored in the refrigerator and reused
within a few hours. If there is no refrigerator in your home, store this
milk in a cool place. Milk which is stored outside a refrigerator must
be used within 2 to 3 hours after being expressed.
As milk deteriorates quickly at room temperature, it is better to
chill or freeze it. Frozen milk will expand in the container so fill it only
3/4th to the top. Frozen milk must be thawed quickly but not in
boiling water as the milk will curdle. Do not leave it to stand in room
temperature. Place the container with its lid covered, under running
cold water, gradually allowing it to get warmer until the milk liquifies.
It is not necessary to boil your expressed milk if it is to’be given to
your baby. Once this milk has thawed, it must not be refrozen.
Use a clean cup and spoon to feed the baby. Make sure they have
been properly sterilised in boiling water to ensure there are no
germs.
42.
What should every nursing mother know about cleanliness and
care of her nipples and breasts?
Every morning while having a bath, wash your nipples and
breasts with plain water. Avoid using soap on your breasts and
nipples as this would remove the natural oils secreted by your
breasts to keep them from cracking. While you do not have to wash
your breasts and nipples before a feed, do remember to wash them
after and dry them well. This precaution will prevent your nipples
from cracking. Cracked or sore nipples can be painful. The impor
tant thing to remember is to wash your breasts and nipples with
water and keep them dry between feeds..
43.
Are the stools of a breastfed baby different from those of a
bottlefed baby?
For the first few days after birth, your baby’s stools will be darkgreenish black and sticky. There is nothing wrong with your baby’s
digestive system. Gradually baby’s stools change during the first week
from dark green to bright yellow liquid stools.
34
The stools of the breastfed baby are usually quite loose and
unformed, and may be yellow to yellow green, to brownish in colour.
The odour unlike that of the bottlefed baby’s stool is mild and not
unpleasant. The stools of a bottle fed baby on the other hand, are
harder and this baby may get constipated.
Frequency of bowel movement varies from baby to baby and
even from week to week with the same baby. Fortunately, because
breastmilk contains enough water for the baby’s need, your baby
does not get constipated (hard, dry stools). Read the answer to
question 5 for more information.
44.
What should a nursing mother eat to maintain her health and to
ensure a good flow of milk?
There is no evidence that any food, drink or vitamins will increase
or decrease the flow of milk, as long as you eat enough of a variety of
foods. However, to produce enough milk for the baby and to main
tain your own health, you should eat a little extra of whatever you eat
normally. An extra helping of rice or chapati, dal, fresh green leafy
vegetables, fish, eggs, meat and fresh fruits will give you all the
nourishment that you need to produce enough milk for your baby
and will help you to maintain your health. ( Illustra'tion 1)
It is sensible to eat according to your appetite and try not to lose
weight. The fat stored in your body during pregnancy will slowly be
lost when you breastfeed. Avoid over-eating. A mother who eats
sensibly will not only provide her baby with plenty of milk, but will
also ensure that her own body isn’t being drained of food resources
to meet her baby’s need.
Even poorly nourished mothers manage to breastfeed their
babies adequately for the first 4-6 months before extra food is
required for the normal growth and development of the baby. How
ever, these mothers breastfeed at the cost of their own bodies-their
bodies lose calcium and proteins. The more babies these women
bear and feed, the poorer their health becomes.
How much extra should you eat while nursing? You should eat
slightly more than you do when you are not pregnant. Is there
anything you should eat more of when feeding the baby? No. Assum
ing that you are eating a variety of food in your normal daily diet, just
35
eat slightly more of everything. This will provide enough nourish
ment both for your baby and you.
45.
Is it true that vegetarian mothers cannot produce enough milk
and so should not breastfeed?
No. This is not true. A vegetarian mother can breastfeed success
fully and produce enough milk for her baby. Traditionally in most
Indian homes, people eat a vegetarian diet, and women through the
ages have lived and reared their children while eating a vegetarian
diet. As long as the nursing mother eats slightly more than what she
eats normally when she is not pregnant, she will produce more than
enough milk for her baby. There is absolutely no reason to fear that a
woman eating a vegetarian diet will deprive her baby of adequate
nourishment. A vegetanan diet which contains a variety of foods like
rice or chapati, dal, fresh green leafy vegetables and other vegetables
'paneer’, curd and fresh fruits will provide enough nourishment both
to produce enough milk and to maintain the mother’s own health.
(Illustration 12)
III. 12: Vegetarian diet for pregnant and nursing mothers.
36
46.
Should a nursing mother drink extra water so that her milk is
not too thick and is easy for her baby to digest?
The amount of water that a mother drinks has no relation to the
consistency of breastmilk, which differs from person to person.
Some mothers fear that their milk is too watery, while others feel
their milk is too thick for the baby to digest. The truth is that the
consistency of breast milk has nothing to do with its quality. Breast
milk, whether thin or thick is perfect for your baby.
In summer, a nursing mother may feel very thirsty. This is hardly
surprising, considering that the baby is taking a great deal of milk
from you everyday. While you should drink as much as you want to,
there is no need to force yourself to drink extra water.
47.
Will breastfeeding spoil my figure?
No, breastfeeding will not spoil your figure. On the contrary,
breastfeeding is nature’s way of restoring your figure. During preg
nancy, a woman’s body stores up fat in preparation for nursing the
baby. This extra fat is used up when the mother starts breastfeeding.
In fact, breastfeeding helps the mother lose the weight that she gains
during pregnancy. In addition, the womb which has stretched to hold
the growing baby, also regains its normal size when a hormone is
released during breastfeeding.
Many mothers believe incorrectly that the shape of their breasts
would change if they breastfeed and therefore choose to bottlefeed.
The truth is that the shape of the breasts change with age and not as
a result of breastfeeding.
48.
Is breastfeeding effective in delaying the next pregnancy?
It has been found that when a baby is exclusively breastfed
without any “top” feeds and is allowed to suckle frequently, both
during the day and night, it can help to delay the next pregnancy.
This happens because the baby’s frequent nursing stimulates the
release ot the hormone ‘prolactin’ that holds back the monthly
preparation for a new pregnancy. Ovulation, the release of an egg
usually does not take place.
Studies show that it is the frequency of nursing and the subse
quent release of the hormone that holds back ovulation. Mothers
37
who keep their babies with them most of the time, at night as well as
during the day, and give frequent, short feeds are more likely to delay
the next pregnancy.
Breastfeeding alone however, will not provide complete protec
tion. A mother who breastfeeds should also take some other precau
tion to avoid pregnancy.
49.
When should a breastfed baby start eating soft foods?
For the first 4-6 months, breastmilk is your baby’s best and
complete nourishment. You don’t need to give your baby anything
else.
By 4-6 months however, the baby’s growing body will need
additional nourishment. You don’t need to buy special foods for your
baby. You can prepare them at home inexpensively from the same
food that you use for the family meal. However, your baby still needs
breastmilk, in addition to its new diet,so continue breastfeeding as
long as you can.
Some mothers don’t start soft foods till quite late, believing
incorrectly that the baby will not be able to eat without teeth. If the
soft foods are mashed well, the baby will have no trouble in
swallowing.
If you delay introducing soft semi-solid foods for too long, the
baby may get so used to its milk diet that it may not show interest in
other foods.
Generally, mothers either start "weaning” or giving semi-soft
foods too early (at 2 or 3 months) or too late (8-9 months) and even
later. Medical studies show that breastmilk is all that your baby
needs for the first 4 to 6 months. After that you should start giving
other foods.
50.
How should I start my breastfed baby onto soft semi foods?
At first give your baby one or two teaspoons of each variety of
food, so that it gets used to a different taste and consistency.
Remember, uptil now your baby has only suckled your breast.
Learning to eat other foods can be difficult. Be patient and don’t
force the baby to eat.
The baby may spit out the food at first. This does not mean it does
38
not like the food. Swallowing soft foods is a new experience for the
baby.If your baby refuses to eat a particular food, don’t give this food
for a few days. Give some other food instead. A few days later, coax
the baby to try that food once again.
Like grown ups, babies also have their preferences in foods.
Some babies prefer sweet things while others like salty food. Be
careful with salty and sweet things. Too much of either food is not
good.
51.
What kinds of food should I give my baby? How much food
“ should I give at each feed?
At first when the baby is about 4-6 months old. start giving a thin
porridge made from either sugi, dalia, ragi, rice powder or atta. Mix a
little oil, ghee or butter in this porridge. This makes the food tastier,
easier to digest and gives extra energy.
At first give one or two teaspoons and gradually increase the
quantity over the next 3 to 4 weeks so that by that time the baby eats
half a cup of porridge.
Fresh fruits like banana, papaya, chikoo and mango can also be
given. Mash the fruit well.. Apples can be stewed and mashed. By the
time the baby is six months old, it should eat a whole banana which
has been mashed well.
While ready-made cereals are available in the market, home
made foods are fresh, cheaper and more nourishing.
By the time the baby is 6-9 months old, seasonal vegetables like
green leafy vegetables, beans, peas and carrots can also be given.
Boil or steam these vegetables. Potatoes are also very nourishing.
Mash these foods well. Add a little oil, ghee, or butter. By this age the
baby can sit up and is beginning to teeth. Give the baby a piece of
toasted bread, a crisp roti, biscuit or a piece of carrot to nibble.
Encourage your baby to feed itself. This is part of its growing and
learning experience.
By 9-12 months the baby can eat a variety of foods that you
prepare for the rest of the family but without the spices added in.
Feed the baby 4 to 5 times a day. Give small frequent feeds rather
than two or three large meals.
Give the baby foods like “kichri”, rice or chapati with dal, idli
39
uppma and dalia. In addition, a variety of vegetables and seasonal
fruits can be given along with curd, boiled milk, egg, khir and bread.
Soften a roti dipped in milk, dal or gravy.
It is better to avoid adding spices to the baby’s food. Add ghee,
butter or oil to the food. By the time the baby is a year or year and a
half old, it should eat all the meals that you prepare for your family.
The food may still need to be softened and given without spices.
By this time, the mother’s milk will probably have decreased, so
most of the baby’s nourishment has to supplied by solid foods. Since
these foods are bulky and the child cannot eat more than 2 or 3 oz. at
a time, it is better to give frequent feeds about 5 times a day, every 2
to 3 hours.
52.
When should I start giving the baby water to drink?
For the first 4-6 months, breastmilk supplies all the nourishment
and water that your baby needs. You can start giving water when the
baby starts its new semi-solid diet. In hotter climates you can give
water earlier, but avoid feeding through a bottle. Instead give the
water with a cup and spoon after they have been properly sterilised.
Boil the water for ten minutes. Cool this water and feed baby with
a teaspoon. Avoid using feeding bottles. By the time the baby is 7-8
months old, it can learn to drink from a glass.
53.
Should I give soft foods before or after a breastfeed?
Soft foods should be given between breastfeeds, preferably a
couple of hours after a breastfeed. This is advised because a baby will
not make an extra effort to eat soft foods when it is very hungry. This
is because suckling the mother’s breast comes naturally to a baby,
whereas it has to learn to eat soft foods. A hungry baby will be less
interested in eating soft foods on an empty stomach. Having had a
breastfeed a couple of hours earlier, the baby will not be too hungry
when offered soft food and may show more interest in this food than
otherwise.
On the other ha_nd, if you offer the breast immediately after it has
been fed soft food, the baby will not suckle the mother’s breast
strongly since it is not hungry at that moment. When the baby fails to
suckle strongly, it will not stimulate the breasts to produce more
milk. Eventually the flow of milk may reduce. Therefore, breastfeed
40
your baby and offer it soft foods a couple of hours later. Give the next
breastfeed a couple of hours after its last meal of soft foods. In this
manner, the baby will continue to get the double benefits of its
mother’s milk as well as soft foods.
54.
Are special baby foods available in the market better than soft
foods prepared at home?
Special foods for babies available in the market are based on a
mixture of powdered milk with some carbohydrates like wheat and
rice. These foods which are cereal and milk;based are expensive. On
the other hand, a wise mother can provide her growing baby with all
the nourishment that it needs with the same things she uses to make
the family meal. Instead of spending large sums of money on tins of
baby foods, she can buy good wholesome food for the entire family,
including the baby. Soft foods prepared at home give the baby a
variety of foods, in addition to providing all the nourishment it needs.
55.
What precautions should I take when preparing a meal or
feeding my baby?
Most mothers know the importance of hygiene. But often a busy
mother may overlook some details of cleanliness. Can any mother
afford to take this risk? The hidden dangers, germs that you cannot
see, can lead to illnesses in your family. A baby is more likely to fall ill.
You need to be extra careful if there is a baby at home. (Illustration
13)
Keep your home and surroundings clean. Germs breed in dirt
and contaminated food and water, causing diarrhoea and spreading
diseases like cholera, dysentry and gastro-enteritis. Drinking water
must be strained through a clean cloth, boiled for 10 minutes and
allowed to cool. Store this boiled water in a clean covered container.
It is advisable not to give your child food kept overnight, as this
food is liable to get infected. Therefore always give the baby food
which is freshly prepared. Wash your hands with soap and water
before you cook the meal or feed the baby. Clean all the utensils.
Wash them well before and after use, and rinse under running water.
56.
When should I stop breastfeeding my baby?
As explained earlier, each baby is an individual, with different
needs. There is no fixed age or weight when you should stop to
41
111. 13: Precautions while cooking the meal or feeding the baby.
breastfeed. As long as your baby is thriving, happy and gaining
weight regularly, you should carry on breastfeeding. However, do
start giving soft feeds in addition to breastmilk when the baby is 4 to 6
months old. Gradually as the baby grows and takes more semi-soft
foods, it will demand less to suckle your breasts and gradually, the
less often you suckle, the milk supply will reduce.
How should 1 stop breastfeeding?
You should not abruptly stop breastfeeding but do it gradually.
Were you to stop quickly, you would find yourself with painful and
engorged breasts and an upset baby who cannot understand why
your milk is suddenly denied.
Give up the feed at which you have least milk first. This is usually
the one in the late afternoon or early evening. Give the baby some
thing else to drink. Gradually, after a week, give up another breast
feed and carry on in this way until you are feeding once a day. Most
mothers find it most comfortable to give up the early morning feed
last, as they usually have most milk at this feed. Other mothers prefer
to give up the last feed of the day last of all, as their babies seem to
enjoy this the most and sleep well afterwards.
57.
42
The most important thing to remember is that breastfeeding
should be stopped gradually and not overnight. If your baby asks for
a feed by nuzzling against your breast, after you have stopped
feeding it, let the baby suckle. It will soon realise that there is little, if
any milk there. Some babies, however, may still want to suck for
comfort if not for food.
58.
Should ci mother continue soft foods when the baby is ill?
It is incorrect to stop feeding a baby when it is ill. In fact now the
baby needs nourishment even more so to recover from its illness.
Food will give it the strength to fight other illnesses which can set in
when the baby is already weak.
Soft foods like kichri, dalia, rice or chapati mixed with lightly
cooked dal and vegetables will not harm the baby. Sometimes when
the baby is ill, it may not feel hungry or may prefer to eat food other
than what it normally eats. While recovering from its illness, the
baby’s appetite will improve and the baby will want to eat slightly
more than what it usually eats. Mothers should use this opportunity
to feed their babies well during their convalescence from illness, as
the additional nourishment will help babies regain their health.
59.
Why does baby haue diarrhoea while teething? Is it because it is
teething, or the fact that I haue started giving it soft foods?
Often mothers lend to associate teething with diarrhoea. This is
incorrect. Diarrhoea occurs when the baby eats contaminated food
or drinks water which is contaminated. Moreover when a baby is
teething, it tends to pick up things lying around the house and chew
on it. These objects can carry germs into its body and cause
diarrhoea.
If you prepare soft foods hygienically, there is no reason why the
baby should have diarrhoea. Introducing soft foods will not cause
diarrhoea, as long as they are well prepared. Wash your hands
before you make the meal or feed the baby. Use fresh food. Use
clean drinking water. Keep the utensils clean. These precautions will
help to prevent diarrhoea. (Illustration 13)
60.
What is diarrhoea?
Diarrhoea is not a single disease. It is a symptiom that accompan43
preparing the salt and sugar solution at home, as explained in the
answer to question 64.
66.
When does a baby with diarrhoea need medical help?
Your baby needs medical attention immediately if it shows any of
the following signs:.
o passes no urine for over six hours;
• vomits so much that it cannot drink or hold liquids;
• shows signs of dehydration;
• has blood or mucus in the stool;
° is drowsy or unconscious;
o has high fever;
• if diarrhoea lasts more than two days.
67.
What should I do to prevent my baby from getting diarrhoea?
Diarrhoea is caused by germs which breed in contaminated food
and water, dust and unsanitary surroundings. These germs enter the
baby’s body through contaminated food or water.
There are simple measures you can take to prevent diarrhoea.
Keep your home and surroundings clean. Flies gather around dirt.
Flies carry germs. Therefore it is important to keep drinking water
and food covered.
For drinking, it is better to use water from a piped water supply, a
deeptube well or a covered well. If water from any of these sources is
not available, boil all drinking water for 10 minutes. Store in a clean
covered container. For more information read the answer to ques
tion 63. Use a special pot or container to store this water. Never put
your hand into the water pot.
Keep all utensils clean. Wash them before and after use under
running water. Never give your baby food left overnight. Give baby
freshly prepared food. Wash your hands with soap and water before
you cook the meal or feed the baby. If the child eats by itself, wash its
hands well before it eats.
Wash your hands with soap and water after going to the toilet as
well as after cleaning the baby who has had a stool. Keep your nails
short and keep them clean. All clothes including undergarments and
bed linen must be clean and fresh. Finally, continue breastfeeding as
long as you can, even when your baby has diarrhoea. Breast milk is
the safest and most hygienic way to feed your baby. (Illustration 13)
46
68.
Is it true that breastfed babies have less chance of netting
diarrhoea?
Yes, it is true that babies who are breastfed exclusively without
top feeds rarely have diarrhoea. Breastmilk is not only free of germs
but also helps to prevent the growth of those germs that cause
diarrhoea. It has been found that bottle-fed babies have diarrhoea
more often than breastfed babies. This is because the feed is not
hygienically prepared. For a bottle feed to be safe, you need to take
many precautions, such as sterilising the feeding bottle and nipple and
boiling the water to prepare the feed. Often these safety precautions
are ignored while preparing a bottle-feed, and the baby can thus be
exposed to the risk of infection.
Breast feeding takes care of all this trouble. Breastmilk is the
safest and most hygienic way to feed your baby. Breastfeed as long as
you can, even when the baby has diarrhoea. Breast milk will give the
baby the best nourishment it needs to recover, besides being easier
for the baby to digest. If the baby is 4-6 months and has started eating
soft foods, also give it kichri or rice mixed with curd, during a bout
of diarrhoea.
69. Since breastmilk contains antibodies, does this mean that a
breastfed baby does not require immunization against common
childhood diseases?
Although antibodies present in the mother’s milk do give immuni
ties to some common childhood diseases, every baby should be
immunised regularly to completely eliminate the risk of these dis
eases. Table 1 gives the immunization schedule.
Breastmilk contains mother’s natural immunities to protect the
baby against illnesses. Breastfeed your baby as long as you can. In
addition,do remember to follow the immunization schedule to com
pletely eliminate the risk of common childhood diseases like tubercu
losis, diphtheria, whooping cough, tetanus, measles and poliomyelitis.
70.
Does every healthy baby require immunization?
Yes definitely. Unlike adults, babies have not built up their own
natural immunities to illnesses. Common childhood diseases can
lead to life-long disabilities, and in some cases, even death. Immuni
zation will protect your child from these dangers.
47
TABLE 1 IMMUNIZATION SCHEDULE FOR CHILDREN
WHEN
WHAT
WHY__________________
3-9 months
BCG vaccine
protect against tuberculosis
3-9 months
3 doses of DPT and Polio
vaccine at intervals of 4-6
weeks each
protect against diphtheria,
whooping cough, tetanus &
poliomyelitis
9-12 months
Measles vaccine
protect against measles
P/2-2 Years
1st booster for DPT and
Polio
77. What are the other things / should know about immunization?
Remember that immunization is effective only when a regular and
complete dose is given. If for some reason the child does not get the
dose in time, it may be given the dose as soon as possible, without
starting the course again.
Minor coughs, cold, mild fever, diarrhoea and malnutrition are
not contra indications for vaccination. In other words, if your child
has any of these illnesses, immunization can still be given without
harming the child.
Sometimes the child may fall sick with the same disease for which
it was immunized, soon after getting the dose. This does not mean
that the immunization was ineffective, but that the child had already
got the disease before the immunization. A disease usually takes
10-15 days to develop in the body before the symptoms appear. If the
child has already contracted the disease, immunization after this
period will not prevent the disease from setting in. Therefore for
complete protection, immunize your child as early as possible, fol
lowing the schedule given in Table 1.
Different vaccines can be given at the same sitting, for example,
DPT, Polio and BCG vaccines. But each vaccination should be given
at a different part of the body, and not at the same spot.
Some of the common and normal reactions to vaccination
include slight fever, local pain and swelling at the site of the vaccina
tion, slight diarrhoea and a mild rash in the case of measles vaccina
tion. Parents should not be alarmed at any one of these reactions as
these are normal reactions and will not harm the baby.
This booklet is provided as a public service by the United Nations Children’s Fund
(UNICEF),Regional Office for South Central Asia, New Delhi.
12/84-30.000
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