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A Practical Guide on
A Practical Guide on
BDEAGT FEEDING
Voluntary Health Association of India
New Delhi
Acknowledgements
Design and layout: Macro Graphics
The guidelines have been prepared by :
Dr. Amla Rama Rao
Ms. Sudha Sobti
Ms.Dilnawaz Mahanti
Ms. Raveena Srinivasan
The technical assistance of
Dr. Samir Chaudhuri
Dr. Shanti Ghosh
is acknowledged with thanks
COMMUNITY HEALTH CELL
326» V Main, I Block
© Voluntary Health Association of India 1990
Kor amongala
First edition, 1990
Bangalore-560034
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system or transmitted in any form or by any means, electric, India
mechanical, photocopying, recording or otherwise, without the prior permission of the
Voluntary Health Association of India.
This book is sold subject to the condition that it shall not by way of trade or otherwise,
be lent, re-sold, hired out or otherwise circulated without the publisher's prior consent
in any form of binding or cover other than that in which it is published and without a
similar condition including this condition being imposed on the subsequent purchaser.
Published by : Voluntary Health Association of India
40 Institutional Area, South of I.I.T.
New Delhi-110 016
Tel. 668071, 668072, 665018, 655871, 652953.
Fax: OH- 676377.
BPEAST FEEDING
A Practical Grade
Introductory
This practical guide is the first in the series on Improved Infant Feeding Practices. It
provides comprehensive information an all that one generally wants to know on the
subject of breast feeding. It seeks to protect and promote the age old practice of breast
feeding as the first step towards better child health.
For Whom
• This practical guide is meant to serve as a teaching aid for trainers of health work
ers.
• It can be used by health workers as an aid during house visits and discussions with
mothers.
• It is also meant for mothers who can read for themselves.
Learning Objectives
After going through this guide, the reader should be able to :
• tell why breast milk is best for babies.
° why bottle feeding is to-be strongly discouraged.
• correct certain misconceptions and faulty practices prevalent in the community,
with regard to breast feeding
• help the mother to cope with with some common problems which occur during
breast-feeding.
1. A breast fed baby is a healthy baby.
i
2. When to start breast feeding.
• The mother must put the baby to her breast as soon after
birth as possible.
The first yellowish milk called colostrum is essential for the
baby.
• It contains certain substances which protect the baby from
infections even later on . These substances are not present in
any other milk.
• Hence colostrum should not be thrown away, as is generally
practised. Most people feel it is bad milk which has stayed in
the breasts for nine months.This is not so.
• Many mothers give sweetened water or some herbal mixture
during the first few days to the baby. These can carry
infection and prove harmful. So such feeds should not be
given.
2
3. Why breast milk is the best food.
4.
• Breast milk is nature's food, designed just for the baby. It is a
nutritionally complete food for the first four to six months of
life. Thereafter also it provides excellent nourishment upto
one-two years of the baby's life.
• Look at this bottle used for feeding the baby. Flies, dust and
dirt are settled on it. The same teat will go into the baby's
mouth, carrying germs of diarrhoea ana other infections.
Why the baby should not be bottle-fed.
• It is far superior to animal milk or expensive tinned milk
powders, and also costs nothing
• The bottles are usually not cleaned well enough. Due to
shortage of water ana fuel, the mother cannot sterilize the
bottles thoroughly even if she wants to. So all kinds of disease
carrying germs find their way into the baby's stomach.
• Breast-milk is more easily digested by the baby than any
other milk.
• It has been noted that the risks of disease and death are 15
and 25 times higher respectively, in bottle-fed babies.
• The whole process of bottle-feeaing is very troublesome.
• Breast-fed babies never have constipation problem. The stools
are soft and freguent but this is not a sign of diarrhoea. They
are normal stools.
® Breast-fed babies do not need any extra water, unless they
are ill.
• Bottle-feeding is also very expensive due to the high cost of
fresh animal milk and powdered milk, the cost of Dotties,
teats, etc.
• There is always a danger of the mother trying to over dilute
the milk or milk powder in order to economise, not realising
that the baby will soon become undernourished.
• All these things considered, it is best to avoid the bottle at all
• Breast milk is most hygienic. It passes straight from the breast
into baby's mouth ana has no chance of collecting harmful
germs
• Breast feeding is emotionally satisfying for both mother and
baby. The baby feels happy and more secure.
3
5.
Some more facts about breast milk.
Posterior Pituitary Gland
Suckling helps the process of milk secretion. Breast milk is reduced if mother is anxious or worried.
milk ducts.
• Have you ever wondered how milk is produced in the breasts ?
© During pregnancy, the breasts enlarge 2-3 times their normal
size and new small ducts and buds are formed from which
milk is secreted.
• The baby's sucking action sends a message to mother's brain
to produce certain hormones. These hormones act upon the
milk glands to produce milk and to release it through the
•
So for milk to be produced and released, it is necessary that
the baby is allowed to suckle the breasts frequently.
• It is also necessary for the mother to be relaxed and free from
worry. Mental stress will inhibit the production of the
necessary hormones from the mother's brain for milk
production and release.
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6. Breast feeding greatly increases the mother's nutritional requirements.
• Milk is made from various nutrients in the mother's blood.
• These nutrients must be provided by the mother's diet. Hence,
her requirements of energy, protein, minerals and vitamins
are greatly increased.
• In order to meet these extra requirements, she needs to eat
more of whatever is the usual family food, such as extra help
ings of cereal, daal, vegetables and milk if possible.
• This extra food intake will help the mothers body to produce
sufficient milk for the baby and also keep herself in good
health.
• The usual practice of depriving a mother of food and water af
ter delivery is very wrong. The older family members must be
made to realise this.
A nursing mother must take more food and water.
5
7. Feed the baby as often as possible.
• Breast milk is easily and rapidly digested by the baby. So it
feels hungry and cries for milk more frequently.
• For the first few weeks, the baby should be fed often, even at
night.
• As we have seen before, the more the baby suckles, the more
will be the milk produced in the breasts.
• In a few weeks, the baby will fix its own feeding pattern about
five to six times a day.
6
8. Continue to breast feed the baby even during illness.
• When the baby is sick and has fever, its metabolic rate
increases, thus increasing the body's energy requirement.
• Fever also causes loss of fluid by sweating.
• There is excess loss of fluids during diarrhoea, which must be
replaced immediately.
• Hence the child needs more nourishment and fluid during
any illness, and breast milk is the best source of both.
• The practice of starving a baby during illness is very wrong
and will make the condition worse. Tne mother must be
convinced that her milk can do no harm to the baby.
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9. An ill mother must continue to breast feed her baby.
• A mother must continue to breast feed her baby even if she is
suffering from illnesses such as colds, viral and other fevers.
• The wrong practice of stopping the baby from suckling the
sick mother's breast will only cause more complications such
as engorgement of the breasts, abcess, etc., which will
increase.the mother's suffering.
• The amount of milk may reduce during the mother's illness,
but it will again increase after recovery.
• The mother must also continue to eat well during her illness.
8
10. Mothers with long lasting diseases who are getting medicines can continue to
breast feed.
• Most medicines are secreted in milk in very small amounts
and do not harm the baby.
• However, a few medicines are prohibited. So before taking
any medicine, it is advisable for the mother to inform the
doctor that she is breast feeding.
9
11. Continue breast feeding during pregnancy.
• A mother must continue to breast feed her baby even if she
becomes pregnant again.
® It is not advisable for her to become pregnant again until her
first child is at least 2 years old.
• However this is sure to put too much stress on her body and
she must be sure to eat more nourishing food.
• For the first four months, the practice of exclusive breast
feeding helps to prevent a next pregnancy. Thereafter some
other method of oirth control must oe used.
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12. SOME PROBLEMS
1. Flat and inverted nipples
Most women have normal nipples i.e. they are
protruding from the surrounding aereola, which
makes sucking easy for the baby.
However some women have short flat nipples.
Few women may have inverted nipples.
If the nipples are flat, squeeze the nipples and pull
them gently. This should be repeated for several
minutes every day, before chila birth and before each
feed.
• Position the baby so that most of the aereola is well
inside its mouth. The suction caused by the sucking
will elongate the nipple.
COMMUNITY
HEALTH CELt
326, V Main.
k
1 Block
^ang3iore-560034
x teaia
11
..............
2. ENGORGEMENT
Cupping method to express milk
If a breast is not emptied normally, it becomes
painful, hard and swollen with milk (it becomes
engorged). Prevent and treat engorged breasts
by emptying them regularly. Frequent suckling
helps to prevent engorgement.
1. Heat a tumbler with
narrow mouth.
2. Fix it onto the breast,
covered with a piece of
cloth.
Encourage regular feeding from both breasts.
Make sure that one breast is emptied before
putting baby to the other breast.
3. Milk will be sucked out of the
breast due to vacuum in the
vessel.
12
3. SORE NIPPLES
• The most common cause is wrong positioning of
the baby with only the nipple in its mouth, so
that it has to suck harder for a longer time in
order to get the milk.
• Sometimes the soreness developes into a bleeding
crack which is very painful.
To prevent and treat sore nipples:
{
• Correct the position of the baby, so that nipple and aereola / \
both go into the baby's mouth.
/
• Start feeding on the nipple that is not sore, as the initial
sucking is the strongest and most painful.
/
/
• Frequent short feedings promote healing as this prevents the\
nipples from drying ana cracking.
\
• Leave a drop of breast-milk on the nipple after feeding - it
helps the skin to heal.
• Apply some edible oil or ghee for relief between feeds.
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Prime Messages
• Breast milk alone is the best possible food and drink for a baby in the first four
to six months of life.
• Babies should start to breast feed as soon as possible after birth. Virtually every
mother can breast feed her baby.
• Frequent sucking is needed to produce enough breast milk for the baby's needs.
• Bottle-feeding can lead to serious illness and death.
• Breast feeding should continue well into the second year of a child's life and for
longer if possible.
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• This practical guide is the first in the series on Improved Infant Feeding Practices. It is
meant for anyone involved with Mother and Child Health. It provides comprehensive
information on breast feeding and tells you some things you would like to know on the
subject. It is kept simple and illustrative so that it can also be used as a visual aid
during inter-personal communication sessions with mothers.
• The Voluntary Health Association of India (VHAI) is a secular, non-profit organisation.
The main objective of the association is to strengthen health programmes by creating
an awareness about the health situation in the country. Its major activities are
production and distribution of books, pamphlets, flash cards, flannel graphs, film
strips and slides on basic health care for the use of various health functionaries of the
village level, campaigns on issues such as drugs, tobacco, baby foods, etc.
documentation or relevant materials for the use of activists and training workshops
and programmes for Community Development and Community Health Workers.
Printed by de-cine comm. & mktg. 626382
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