INFANT AND YOUNG CHILD FEEDING
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- INFANT AND YOUNG CHILD FEEDING
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In fa n t and Young Child Feeding
SDA-RF-CH-1.38
Update - 4
Not Enough Milk
Almost al! mothers can successfully breastfeed their babies if they are well informed and adequately
supported e.g. community supports breastfeeding and values it, women receive adequate care and support
from haelth care providers and work places have supportive environment. Breastfeeding is the right of
every mother and the child. Mothers, even in malnourished states have demonstrated the ability to provide
sufficient breastmilk to their babies because it is the "suckling " that controls the whole process of breastmilk
production and is the key to success.
Mothers say " I dont have enough milk" . this is the story in every home in this world, east or west,
north or south, rich or poor. Commonest reason given by mothers all over the world for introducing
supplementary milk early or even terminating breastfeeding her baby, is the belief that she does not have
enough milk for her baby. Mothers often worry about the amount of breastmilk they produce as early as the
first day after delivery. This is sometimes represented as being 'socially acceptable' excuse for discontinuing.
rather than being a real (i.e. physiological) problem. Sometimes relatives, friends or health workers suggest
to the mother that she may not have enough milk. Thus the mother's confidence in her ability to meet the
baby’s needs is easily undermined when they ask a loaded question, "is your baby getting enough?" this is
enough to worry many mothers so much that their milk production falls off and their babies don't get
enough! hi this issue >i'e, therefore, Qilpbe dealing with the problem of "Not Enough Milk" and how can
health professionals help mothers to overconre their problem.
The Problem
when the baby suckles more due to increased
A baby’s need for milk and his/her mother's
secretion of 'Prolactin'. This is the key to enough
ability to produce it just in the right quantity have
or even abundant breastmilk supply and a contented
been said to be one of the nature’s most perfect
baby. Sometimes, a baby may not get enough
examples of the law of demand and supply. Until the
breastmilk. Usually this is because the baby is either
advent of production of artificial milks , the very
not suckling enough, or is not suckling effectively
survival of the human race depended largely on
because s/he is not sucking in a correct position.
mother’s ability to produce a sufficient quantity of
Mothers who think that they do not have enough
milk to adequately nourish her baby.
breastmilk need assistance and support of a skilled
Even when a mother perceives her milk to be
person.
insufficient, the baby usually gets all the milk s/he
needs. The fact is that the amount of milk, which the
Almost all mothers can produce enough breastmilk
breasts produce, is determined by the amount that
for one or even twins, provided the baby suckles
the baby needs. Breastmilk production increases
effectively and breastfeeds as often as needed.
Dear Reader,
Malnutrition in children is a major problem facing us and to reduce it, a multi-faceted approach is
essential. We at BPN1 set up an expert group to review the areas which require special focus in the health
sector. Its outcome, the Infant and Young Child Feeding Update will provide you information on caring
practices that can aide in reducing malnutrition in the young child. We welcome your valuable contri
bution based on your experience.
2
Not Enough Milk
How to tackle the problem:A practical approach for health
professionals would be to:
1
weight gain.
the baby is breastfeeding frequently on both breasts.
First, decide whether the baby is getting enough milk or
Most newborns usually breastfeed every two to three hours
not.
or eight to twelve times in twenty-four hour period. This is
2
If the baby is not getting enough breastmilk, evaluate why.
an average, and some babies may demand breastfeed less
3
Decide how to help the mother and the baby.
frequently while others more often.
®" the baby appears healthy.
l.Decide if the baby is getting enough.
Ton can be confident that the baby is getting enough milk:
if the baby is gaining weight at an average of 500 grams
If the Baby is not getting enough
breastmilk, evaluate why?
per month or approximately 20g a day. (A weight loss of
If a baby is not getting the breastmilk it needs and is not
up to 10% is considered normal during the first week of
gaining weight adequately, try to understand why. Listen to the
child’ birth. This may be due to the shedding of excess
mother and learn about her situation. Try to understand wh^j
fluids, largely from placental blood and baby’s passing of
she believes her milk is insufficient, and what are her feelings
the meconium (the first stool). In order to establish that
about her baby and about breastfeeding. Take history & observe
the weight gain has been appropriate, at least two weights
a breastfeed. Table 1 summarizes the reasons why a baby may
need to be compared. A minimum useful interval is two
not get enough breastmilk. The reasons listed under
weeks, in which a baby should gain 250 grams or more.)
Breastfeeding factors and Mother’s psychological factors
the baby has passed light colored urine six times or more a
are common and often go together. For example, lack of con
day [6 wet "\angots” (napkins) or more] and is receiving
fidence in herself to provide enough milk leads a mother to give
nothing but breastmilk-not even water or formula milk. A
bottle-feeds, and giving bottle-feeds further reduces her confi
baby’s urine output is a useful sign for monitoring a child’s
dence as it affects oxytocin reflex which in turn reduces milk
breastmilk intake daily, while waiting for information about
flow.
Table 1
1.
Reasons why a baby may not get enough breastmilk
These are COMMON
These are NOT COMMON
Breastfeeding factors, how these affect
breastmilk production and flow.
If the first breastfeed is delayed pas^|
Breastfeeding
factors
Mother:
psychological
factors
Mother:
physical
condition
Baby's
condition
few days, it is more difficult to establish a
good milk How, which may affect the
amount of milk the mother produces later
Delayed start
- Lack of confidence
■ Using contraceptive
■ Illness
Infrequent feeds
■ Worry, stress
pill, diuretics
• Physical
• Dislike for
• Pregnancy
abnormality
• Short or
breastfeeding
• Severe malnutrition
interrupted feeds
• Rejection of baby
• Alcohol
• Scheduled feeding
• Tiredness
• Smoking
• No night feeds
• Poor attachment
Boules, pacifiers
• Retained piece of
placenta (rare)
(help mothers initiate breastfeeding within
half an hour of birth);
Infrequent breastfeeding will produce
less prolactin leading to less milk production;
No night-feeding leads to less
prolactin production and hence, reduced milk
supply;
• Complementary
• Poor breast
feeds
development (very
®
• Top feeds
rare)
feedings again leads to less prolactin release;
Infant and Young Child Feeding
Less suckling stimulus during shorter
®- Scheduled feeding interferes with the supply and demand
allowed to suckle uninterrupted more frequently (at least
of milk production:
ten times in 24 hours or more if the baby is willing) and for
When the baby is incorrectly attached to the breast,
breastmilk is not effectively transferred; it may appear that
as long as he wishes.
®-
the breastmilk is not enough.
normally increases between 3 and 6 months of age, whereas
«" Use of bottles and pacifiers may lead to nipple confusion;
that of infants who begin receiving solids, breastfeeding
«' Addition of any other fluids/foods before six months would
actually lead to less suckling stimulus, which in turn, will
Breastmilk intake by infants who are exclusively breastfed
will decline (Heining et al. 1993)
®-
If the baby is less than four months old and the mother
lead to less prolactin production and hence, reduced milk,
gives supplementary milk feeds, help her to reduce them.
supply.
She should use a cup (not a bottle) and this should be
offered after the baby has breastfed for as long as he wants
2.
Psychological factors of the mother
- not instead of a breastfeed. Make sure that the
k
Lack of confidence in the mother about her ability to
supplementary milk feed is hygienically prepared and not
^produce enough amount of milk sets out a cycle of poor
over diluted.
confidence, less secretion of oxytocin, apparent poor supply,
Avoid use of bottles, teats and pacifiers. If artificial feeds
worried mother, crying baby and introduction of bottle/artificial
are needed until an adequate milk production is established
feeding. Promotion of infant formula and free samples can
feed them by cup.
further undermine mother’s confidence in her milk supply.
Follow up daily until the baby starts gaining weight, then
Stress and worries also lead to poor oxytocin reflex.
weekly until the mother has gained confidence and her
baby is gaining weight satisfactorily.
3.
Physical factors of the mother and the baby
Mother's physicial conditions are uncommonly associated
with not enough milk and so are baby's conditions and should
A mother who thinks that she does not have enough milk
a-
Understand her situation. Take a history do not ask whether
you have enough milk but try to understand why the mother
only be considered if no other reason is found.
doubts her milk supply and explain how breastfeeding
Decide how to help the mother and the
^>aby
works.
Did you know?
If the Baby is not getting enough breastmilk, decide how to help
the mother and the baby. Understand for situation
v
Explain to the mother the possible reasons for her baby
not getting enough breastmilk after ascertaining the factors
mentioned above. Reassure her that her breasts can produce
as much milk as her baby needs.
Keep the baby close to her and not give the baby to other
care givers. She should keep the baby with skin to skin
contact and breastfeed at night.
®”
Restore the mother’s confidence and explain to her how it
helps in milk production. Help the mother to improve her
baby's attachment at the breast. The baby should be
>=>
The mother’s dietary intake has no effect on her milk
supply. Even if the mother's diet is less than ideal, her
milk supply will be adequate for her baby. Only mothers
who are chronically or severely malnourished have
reduced milk supplies. Ruth A. Lawrence says ,” All over
the world women produce adequate and even abundant
milk on very inadequate diets”. (Lawrence R.A.
Breastfeeding: A Guide for the Medical Profession, 3rd
edn. St. Louis: Mosby; 220-244,1989).
Mothers can produce enough milk to feed twins and even
triplets.
Not Enough Milk
Commonly asked questions by mothers
4
Help mother to improve baby’s attachment at the breast.
Commonly asked questions
Build her confidence. Show her that the baby is gaining
weight and reassure her that he is getting enough breastmilk.
Babies cry a lot when hungry, there may be some other
reasons of crying . Suggest some ways to comfort the
QI. Is there any drug that may increase the milk supply?
baby who cries a lot - commonly used methods are: hold
Response: Some drugs have been reported to increase supply,
the baby, stroke him. put light pressure against the abdomen;
but frequent suckling at the breast and avoiding bottle feeds is
enough to ensure adequate supply of milk than medicines to
increase your milk. Metoclopramide is known to enhance
prolactin secreation but dose not replace counselling to build
confidence of mothers.
change his clothes; burp the baby several times during a
feed and sometimes just a change of place helps.
Explain the advantages of exclusive breastfeeding and the
dangers of unnecessary supplements.
Inform the mother about how breastfeeding works and role
of oxytocin reflex in breastmilk flow and how confidence
can help her to come out of the problem.
Talk to close relatives.
Follow up each week until she has gained confidence.
The main way to increase the supply of breast milk is for
the baby to suckle to stimulate milk production. .
Resources
Following publications are available at BPNI Resource Center, in case you need
B
The Law to protect and promote breastfeeding. A book that explains the provi
sions of the IMS Act in a simple manner. Rs. 40 each
n
Under Attack - An Indian Law to Protect Breastfeeding - A report on die monitoring
of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of
Production, Supply and Distribution) Act, 1992 (The IMS Act) Rs. 100 each
0
Commercial Infant Foods - Analysis ofPromotion - A report on the ways and means
of promotion use by the manufactures Rs. 100 each
Breastfeeding and Infant Feeding (xhw oHr Dtfj smrrr) -A Guide for the
parents (m Hindi and English)
0
Rs. 10 each
Human Lactation Management Training (HLMT) Course Module. A course for
Doctors, Nurses & Breastfeeding Counsellors (In English). A set widi slides and
transparencies.
Rs. 3500 each set
B
Helping Mothers to Breastfeed an ACASH (Mumbai) publication.
0
Maternity Home Practices & Breastfeeding an ACASH (Mumbai) publication.
Rs. 75 each
0
Poster "Closeness and Warmth" 15” x 20"
n
H
Rs. 100 each
Rs. 10 each
Breastfeeding Posters 12" x 18" (in English & Hindi) Rs. 5 each
Video: Maa Ka Pyar - Sishu Ahaar
Q2. To incraese her milk supply, should the mother drink large
amounts of extra fluid?
Response: This fallacy is most often expressed in the admonition
to the newly lactating mother to "drink as much fluid as possible."
or to drink a specific number of glasses of water or milk
throughtout the day. In a recent examination of this question,
researchers observed that a 25 percent increase (range 26%-140%)
in water above normal fluid intake resulted in no significant
change in milk production. They concluded that no benefit was
realized with a marked increase in supplemental fluid intake.
Drinking to quench thirst is sufficient.
Q 3. When does the lactating mother’s milk come in?
to order, please send your payments through DD in favour of "BPNI Delhi
Q
There are certain questions, which mothers normally ask you;
we provide suitable responses here to facilitate your answers.
Response: Although normal breast fullness usually occurs one
to three days after the infant begins suckling, this is not to say
that no milk exists prior to that time or that the baby does not
obtain nourishment. Milk truly starts "flowing" on day 3 onwards.
Colostrum, a highly concentrated source of protein and
antibodies, is produced as early as the third month of the
pregnancy. It continues to be produced through the second
week of the infant's life, gradually declining in both volume and
proportion by around the beginning of the third postpartum week.
When the placenta is delivered, prolactin-inhibiting factor, the
primary barrier of full milk production during pregnancy, is
removed, thereby allowing production of mature milk. The
proportion of colostrum declines as the proportion of mature
milk increases.
fii?f ormrt) Language: Hindi,
Duration: 13 minutes, this video covers early, exclusive breastfeeding, how to
breastfeed and complementary feeding
Rs. 250 per cassette
In our next issue we will cover Breastfeeding Problems
and Breast Conditions
Infant and Young Child Feeding:Update -4. is a publication of the Breastfeeding Promotion Network of India
(BPNI), under the project "Information for Action", supported by UNICEF, India and the Department of Women &
Child Development, Government of India.
Compiled & Edited by: Dr. Jagdish C. Sobti, Ruchika Chugh, Dr. G.P. Mathur
Designed by: Amit Dahiya.
Breastfeeding Promotion Network of India (BPNI), BP-33, Pitampura, Delhi-110088
Phone: (+91)011 -7443445, Fax (+91) 011 -7219606,
E-mail: bpni@bpni.org, Website: http://www.bpni.org
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