INFANT AND YOUNG CHILD FEEDING UPDATE-3

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Title
INFANT AND YOUNG CHILD FEEDING UPDATE-3
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In fa n t and Young Child Feeding

SDA-RF-CH-1.39 C h"t < / ■

Update - 3
Problems in Initiating Breastfeeding
The joyous moment of birth comes not only after many hours of difficult time during labour but also at
the end of nine months' waiting and preparation for the baby's arrival. Not surprisingly, the majority of

mothers experience a tremendous sense ofphysical relief and emotional excitement when the baby is finally

born. Feelings of pride mingle with fatigue, curiosity and sense of elation, at having actually produced a
baby that a few hours ago was nothing more than a wriggling bump. A few mothers are so exhausted by

their labor that all they can think of is having a well-earned rest and unfortunately some are so knocked out
by the effects of pain-killing drugs that they can't think of anything at all.

In this issue we will deal with the problems faced by mothers in initiating breastfeeding and how they
can be tackled we also discuss how breastfeeding milk is produced and transfered to mothers.

Excessive dose of painkillers during labour, cultural beliefs and taboos, lack of awareness and inad­

equate support of healthcare providers and family members are all responsible for late initiation of
breastfeeding.

The first few days

the first half-hour after birth and thereafter it fades.

Immediately after delivery the first few hours

If feeding at the breast is delayed for 24 hours, the

are very important for the mother and the baby. Early

infant may need to be taught how to suckle, particu­

initiation of breastfeeding helps to develop a bond

larly if bottles or pacifiers have been given during

between the mother and the baby. It ensures secre­

that time. The use of bottles or pacifiers to a baby

tion of colostrum which, is highly nutritious, pre­

produce “nipple confusion”.

vents neonatal infection and therefore reduces risk

Therefore, it is very important for the healthcare

of hospitalizations in newborn period, reduces ma­

provider to give proper information and provide

ternal postpartum bleeding, stimulate contractions

help al the time of delivery to the expectant mother

& expulsion of placenta and helps to establish

and the family regarding early initiation.

breastfeeding successfully. Mothers are more likely

Recommendation: breastfeeding should be initi­

to succeed and to continue with breastfeeding if the

ated within first halfan hour ofbirth (Step 3 of Ten

baby stays with them 24 hours a day from the time

Steps to Successful Breastfeeding)

of birth, and they get skilled help and support from
the beginning.

In our society mothers face lot of problems ini­
tiating breastfeeding within half hour of birth. The

Research has shown that when mothers do not

first feed should be given in the delivery room, be­

start breastfeeding early, their babies do not develop

fore handing over to the parents and should be­

normal feeding patterns until the fourth or fifth day.

come part and parcel of revival practices.

The reason is that the suckling reflex is strongest in

Why such problems: There are certain beliefs and

Dear Reader,
Malnutrition in children is a major problem facing us and to reduce it, a multi-faceted approach is
essential. We at BPNI 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 to reduce malnutrition in the young child. We welcome your valuable contribution
based on your experience.

2

Problems in initiating breastfeeding
practices that do not encourage early initiation, thus creating op­
portunities to give artificial/bottle feed to the newborn baby.

O

Lack of awareness regarding importance of early initiation.

□

Lack of counselling and practice help by the health workers

to initiating breastfeeding.
□

O

connective tissue, which determines the size of the breast. (See
Fig. 1)
Milk is produced inside the glands under the influence of

‘prolactin' (a hormone released from anterior pituitary gland). The

Family members and sometimes health professionals believe

milk flows into the ducts under the influence of oxytocin , a hor­

that the mother needs rest and consider breastfeeding a dif­

mone released from posterior pituitary. Finally breastmilk it is stored

ficult experience.

temporarily in the lactiferous sinuses.

Belief by certain people/communities that thick yellow milk

(colostrum) that comes during the first few days is not good

Breastmilk Production
As the baby suckles on the breast it provides a sensory stimu­

for the baby.

□

nuses. This system of sinuses and ducts are interspersed in fat and

Practice that does not allow the mother to initiate

breastfeeding till an aunt arrives and washes mother’s breast.

lus through nerve endings in the nipple to the anterior pituitary
glands resulting in the prolactin release known as the prolactii^

reflex. This acts on glands in the breast for milk secretion. Thus,

How breastfeeding works

milk production is dependent on the suckling stimulus (Fig 2).

Anatomy of the Breast

Once you understand how breastmilk is produced it will be

easier for you to explain it to the mother. The human breast consists
of the nipple, the areola and the soft tissue (Fig 1).
The breast tissue is composed of alveoli the glands, which

are small sacs, made up of millions of milk secreting cells. Their
ducts open outside at the nipple area. While these ducts are be­

neath the areola, they become wider to form the lactiferous si-

Fig. 2: The prolactin reflex or the milk secretion reflex

Prolactin is present in the blood for about 30 minutes after

the baby finishes the teed. It makes the breast produce milk for the
NEXT FEED. Message you could pass on to the mother is, "If

your baby suckles more, the breast will produce more milk”.

For the same reason if a mother has two babies breastmilk produc­

tion increases due to increased suckling.

Prolactin is responsible for breastmilk production
Fig. 1: Anatomy of the breast

Infant and Young Child Feeding

When and What to do?
Breastmilk Flow
Suckling by the baby also induces the production of

When and What to do?

‘oxytocin the hormone responsible for milk flow, this is known as
the oxytocin reflex (Fig.3). Oxytocin acts on the muscle cells

When?
Start counselling pregnant women during antenatal pe­

around the alveoli causing the ejection of milk. Oxytocin is

riod, as this is the most useful time to prepare mothers

produced quickly with the start of the suckling and sometimes

for optimum infant feeding practicesand early

even before that. It is produced NOW FOR THIS FEED and is
responsible for milk transfer from breast to the baby. If not produced

adequately, the baby may have difficulty in getting the milk. It

initiation.

What?
During the antenatal period you should counsel mothers regarding:

may seem that breast is not producing milk in fact it is there, but

Importance of early initiation of breastfeeding

not flowing. Oxytocin also makes the uterus contract and controls

Nutritional and immunological advantages of breastmilk

postpartum bleeding.

(colostrum and mature milk), and the known hazards of

Oxytocin release is affected by mother’s feelings and her men­

bottle-feeding, e.g. higher chances of asthma and allergy,

tal state. Good feelings, thinking lovingly of her baby, feeling

spending extra money on bottle feeding and explanation

confident that her milk is the best and enough for the baby, can

regarding hassles of preparing artificial feed and its eco­

help oxytocin reflex to work better. The sight and sound of her

nomic impact.

baby help augment the oxytocin reflex. Negative feelings like

Instruction regarding the techniques of hand expression

pain, worries, tension, lack of confidence and doubts in mother’s

of breastmilk and the ways to collect and store it (Ex­

mind about her ability to produce milk inhibit the reflex. (Fig. 3)

pressed breastmilk in clean receptacle covered with lid

You should never make a statement that undermines mother’s

can be kept for 6 hours under ordinary conditions and in

confidence and self esteem.

refrigerate for 24 hours)

Oxytocin is responsible for flow of milk from mother’s breast to

■=>

Explanation of how breastfeeding works, how to prevent
nipple confusion and advantages and importance of room-

the baby’s mouth.

Did you know?
Research has shown that the baby’s instinctive reflexes

are very much active in first 45-55 minutes in which if
the child is placed on his stomach on mother's abdo­
men. s/he would crawl and find mothers breast and nip­

ple. During this period emotional bonding will take
place between mother and child.

ct>

If a newborn baby is given even one bottle feed it can

lead to “nipple confusion" and as a result the child will
refuse to take the breastfeed.

Fig.3: The oxytocin reflex

Problems in Initiating Breastfeeding

4

Applying this information

Applying this information
While assisting or counselling mothers here are some tips to
be kept in mind.
□ Rooming In: Ideally, a new baby should be handed to his
mother immediately after delivery to hold and suckle, for as
long as she wants. If the baby is naked, it is better, as long as
the room is warm enough. It allows mothers to respond to
their babies.
□ Baby should be suckling in correct position with a wide-open
mouth and having much of the areola inside baby’s mouth. No
pacifier or bottle be offered to the baby as it will create “nipple
confusion" or a difficult feeder as these are known to increase
chances of weaning early.
□ Information regarding importance of early initiation of
breastfeeding be provided to all family members and their
fears, if any, should be addressed appropriately.
□ To ensure adequate breastmilk supply, following points should
be emphasized and information must be shared with all family
members.
1. Frequent suckling helps to stimulate milk production. It also
prevents engorgement of breast.
2. Alternate breasts should be offered at each feed. One breast
must be emptied out fully before the second is offered, so that
the baby receives both foremilk (secreted at the start of a feed,
rich in proteins, sugar, vitamins and mineral) and hindmilk
(comes later towards the end of a feed , which is rich in fat
content, and satisfies the baby's hunger).
3. Avoid prelacteal feeds: Water, glucose- water, tea, honey etc.
as these can satisfy the baby’s thirst and hunger. Thus, baby
will not suckle vigorously at the breast, which in turn will
adversely influence the milk production. Prelacteal feeds also
increase the risk of infection,
4. Avoid bottle feeds: to prevent nipple confusion and infection.
5. Duration of each feed: The baby should be allowed to
breastfeed unrestrictedly and on demand schedule to ensure
adequate suckling stimulus for prolactin production.
6. Duration of breastfeeding: A baby should be exclusively
breastfed for the first 6 months. Any supplementary foods given
to the baby before or during this period increase the risk of
reduction in breastmilk production, infection, allergies and
malnutrition setting in.
7. Teach mother about proper positioning and attachment.

'Commonly asked questions^
Q 1. My baby wants to suckle only one breast and not the other.
What should I do?
Response: Breast preference is known. The baby may not want
to suckle one of the breasts if it finds easier to suckle the other
breast or does not get milk from the first. This can happen if your
nipple is sore or the breast is engorged. Expressing some milk
before the baby starts feeding will relieve this. You should
breastfeed from the breast that the baby likes to suckle and wait
for the milk from the other breast to flow. If this breast is offered
now, the baby will find suckling easier and satisfying. You may
have to express milk from the breast that the baby does not like,
for many days before the problem is solved. You should not give
up easily.
Q2. When I feed the baby, there is a gush of milk and my baby
chokes. This really worries me. What should be done to solveg
this problem?
Response: Some mothers have a strong oxytocin reflex so when
the baby suckles, there is a gush of milk, which is too much for
the baby to handle, and thus s/he chokes. If your milk flow is too
fast for the baby to handle, you should express your milk few
seconds first and then offer the baby your breast. In this way the
intensity of the flow will reduce and the child will be able to
suck effectively without being choked.

Resources
Following publications are available at BPNI Resource Center, in case you need
to order, please send your payments through DD m favour of ' BPNI Delhi”.
■
■

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
Under Attack - An Indian Law to Protect Brastfeeding - A report on the 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

■

Commercial Infant Foods - Analysis of Promotion - A report on the ways and
means of promotion use by the manufactures Rs. 100 each

■

Breastfeeding and Infant Feeding (M-rni-i oHt fry omtR) -A Guide for the
parents (in Hindi and English) Rs. 10 each

■

Human Lactation Management Training (HLMT) Course Module. A course for
Doctors, Nurses & Breastfeeding Counsellors (In English). A set with slides and
transparencies.
Rs. 3500 each set

■

Helping Mothers to Breastfeed an ACASH (Mumbai) publication.

■

Maternity Home Practices & Breastfeeding an ACASH (Mumbai) publication. Rs.
75 each

■

Poster "Closeness and Warmth" 15" x 20"

■
■

Breastfeeding Posters 12" x 18° (in English & Hindi) Rs. 5 each
Video: Maa Ka Pyar - Sishu Ahaar (m tfi
fry otrnn) Language: Hindi,

Rs. 100 each

Rs. 10 each

Duration: 13 minutes, this video covers early, exclusive breastfeeding, how to

breastfeed and complementary feeding.

Rs. 250 per cassette

Infant and Young Child FeedingtUpdate -3, 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: Ruchika Chugh, Dr. G.P. Mathur
Designed by: AmitDahiya.
Breastfeeding Promotion Network of India (BPNI), BP-33, Pitampura, Delhi-110 034
Phone: (91) 011-7443445, Fax (91) 011-7219606,
E-mail: bpni@bpni.org, Website: http://www.bpni.org

Advertisements of Snfant MsBk Substitutes,
Feeding Bottte and infant Foods are banned
since 8th September 2000
(vide C.S.R. 710(E), dated 8h September, 2000)

Im p o rte d M w o s j O md

by
The Cable Television Networks (Regulation) Amendment Act, 2000
(An act further to amend the Cable Television Networks (Regulation) Act, 1995)

Relevant Provisions of the Act:

Section 1(2): It extends to the whole of India.
Section 6: "No person shall have a right to transmit or re-transmit through a cable service any
advertisement which is not in conformity with the Advertising Code prescribed under rule 7 of the Cable
Television Networks Rules, 1994”.
Rule 7: Advertising Code - Rule 7(2)(viii)(b) states that No advertisement shall be permitted which
promotes directly or indirectly production, sale or consumption of Infant Milk Substitutes, Feeding Bottle
or Infant Foods. ”
Section 16: Offences and penalties - Punishment for contravention of provision of this Act- Whoever
contravenes any of the provisions of this Act shall be punishable,-

(a>

for the first offence, with imprisonment for a term which may extend to two years or with fine
which may extend to one thousand rupees or with both;
(b) for every subsequent offence, with imprisonment for a term which may extend to five years and
with fine which may extend to five thousand rupees.

What you can do!
o Contact your cable operator to stop these advertisements;
• As a subscriber' if you come across any violations through the cable service1
2 you
should also report to the authorised officer3 and pursue for active and effective
implementation, the authorised officers can take action.

Reporting information should include:
Name and Place of the Cable Operator:
Name of the Programme:
Duration/Time:
Date, Month, Year:

Issued in public interest by:
Breastfeeding Promotion Network of India (BPNI)
BP-33. Pitampura, Delhi 110 034
Tel: 11-7443445, Tel/Fax: 11-7219606
Email: bpni@bpni.org

1 "subscriber” means a person who receives the signals of cable television network at a place indicated
by him to the cable operator, without further transmitting it to any other person.(Section 2[i])
". "cable service" means the transmission by cables of programmes including re-transmission by cables
of any broadcast television signals.(Section 2|b|)
' "authorised officer” means within his local limits of jurisdiction - (i) a District Magistrate, or (ii) a
Sub-divisional Magistrate, or (iii) a Commissioner of Police.

BPNI Resource Center for

;

Infant and Young Chi Ed Nutrition

j

;

'L--------------------- ----------------------

Breastfeeding Promotion Network of India (BPNI) was founded on 3fd December, 1991 at Wardha, Maharashtra. BPNI is a
national network of organizations and individuals dedicated to promote mother and child health through protection, promotion

and support of breastfeeding. It is the Regional Focal Point for the World Alliance for Breastfeeding Action (WABA) and

International Baby Food Action Network (IBFAN). BPNI has a Resource Center for Infant and Young Child Nutrition at its
HQ Delhi.

Documents available at the resource center include:
•

Books
1. The Law to protect and promote breastfeeding.
2.

(Modules. OHP's & Slides).
3.

4.

Helping Mothers to Breastfeed (an ACASH
publication).

Human Lactation Management Training Course

5

Maternity Home Practices & Breastfeeding (an
ACASH publication).

Breastfeeding and Infant Feeding - A guide for

parents (Hindi & English).
o

•

Reports
1.

Commercial Infant Foods- Analysis of Promotion

3.

Under Attack 2000

2.

Under Attack 1998

4.

Effect of BPNI Campaign

BPNI Bulletin (Number I - 17)

»

Updates - Infant and Young Child Feeding Update (Number I & 2)

•

Videos - BPNI Video Cassette “Maa Ka Pyar- Shisti Ahar” (Hindi, 12 minutes), and several video cassettes from other

related organizations in the world.

•

BPNI Posters

1.

2.

Closeness and Warmth

Advertising,

8.

Economics of breastfeeding,

Baby Friendly Hospital Initiative (BFHI).

9.

Human milk banking.

Breaslfeeding/Infant Feeding practices in various

10. Lactation Amenorrhea Method (LAM) and

The Magic only a mother can do. (Hindi &
English)

•

Reference papers under following heads:
1.
2.

3.

cultures.

breastfeeding,

4.

Campaigns on infant feeding.

1 1. Nutrition issues

5.

Comparisons between breastfeeding and

12. Preterm/Low birth weight infants,

bottlefeeding.

13. Complementary feeding.

6.

Diarrhoea and breastfeeding,

14. Training of health professionals in breastfeeding

7.

Drugs, chemicals and virus transmission in
human milk.

& lactation management.

15. Working women and breastfeeding.

In case you need any document/information, we will be too happy to share with you, on a no profit basis.
As we are constantly updating our resource center, we request you to kindly send us your published/unpubhshed articles and

books and any other information which you would like to share with us and others. Please also inform other interested persons
about the resource center. Your cooperation and support be highly appreciated.

Prof. G P Mathur
Office in-charge Resource Center
Address: BPNI. BP-33. Pitampura, Delhi 110088. Tel: 011-7443445, Fax: 011-7219606, Email' bpni@bpni.org
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