The period from birth to 18 months of age is considered to be a narrow age window that coincides with a time of breastfeeding followed by complementary feeding. The global recommendations are given by World Health Organizations for breastfeeding and complementary feeding are:
1. Exclusive breastfeeding till six months of age; thereafter introduction of complementary foods.
2. Maintenance of breastfeeding till two years of age.
3. Responsive feeding that is assisting older children, feeding patiently, encouraging children to eat, but not force feeding.
4. Safe preparation and storage of complementary foods including hand washing and use of clean utensils.
5. The amount of complementary food needed – appropriate for child’s age.
6. Food consistency according to child’s age
7. Meal frequency and energy density according to the child’s age
8. Nutrient content of complementary foods including dietary diversity
9. Use of multi – vitamin supplements or fortified products for infant and mother.
10. feeding during and after an illness.
Breastfeeding should be initiated within half an hour of birth. There are many benefits for initiating breastfeeding early. These are:
• infants are most active during the first 30 to 60 minutes after birth
• At birth, the suckling reflex is also most active
• It ensures the intake of colostrum
• It promotes emotional bonding between the mother and child
• It prevents breast engorgement, and
• It prevents postpartum bleeding.
According to the survey conducted by National Family Health Survey, in India, only 25% of infants were breastfed within an hour of birth and nearly half of the mothers did not initiate breastfeeding within one day of birth.
Human milk or breastmilk is an ideal food for the infant during first six months of life. It ensures proper growth and development. Human milk contains immunoglobulins, T lymphocytes, enzymes such as lysozymes and phagocytes, that protects infants from infections. There are three phases of breastmilk: colostrum, transitional milk, and mature milk.
Colostrum feeding is essential to feed infants on the very first day of birth. Colostrum is thick and yellow in color. The yellow color as it has a high concentration of beta-carotene. It is highly nutritious and contains anti – infective substances that protect the infants from infection. It helps in building up the stores of nutrients and antibodies in the infant’s body.
However, in India, there is a practice of discarding colostrum. Some of the reasons reported in various studies are mothers consider colostrum as dirty and indigestible, lack of knowledge about the importance of colostrum, some mothers dislike the color of colostrum. Other barriers include lack of family support, discouragement of early initiation of breastfeeding, caesarean delivery and feeding of pre-lacteal feeds.
Transitional milk describes the post-colostral period i.e. 7 to 21 days postpartum. During this period there is little changes in the composition of breastmilk. Transitional milk consists of high levels of fat, lactose, water-soluble vitamins and contains more calories than colostrum but contains lower levels of immunoglobulins.
Mature milk i.e. period after21 days postpartum. Mature milk appears thinner, paler and is more watery compared to the colostrum. It consists of 90% water required to maintain hydration of the infant and 10% consists of carbohydrates, proteins, and fats that are required for growth and to meet energy requirements of an infant.
Exclusive breastfeeding means that babies are given only breastmilk and nothing else, that is no other milk, food, drinks and not even water. Exclusive breastfeeding should be practiced for first six months. During this period breastmilk alone is adequate to meet the hydration requirements of infants even under the extremely hot and dry summer conditions prevailing in the country. Breastfeeding should be given on demand that is as and when the infant demands breastmilk during the daytime as well as night. Mothers should not use bottles, teats or pacifiers. Exclusive breastfeeding reduces the infant mortality.
It also lowers the risk of many common illnesses like diarrhea, gastrointestinal infections, pneumonia and urinary tract infection. Mothers also benefit while exclusively breastfeeding the infant. They return to their pre – pregnancy weight very fast and reduces the risk of developing type II diabetes. The mother should breastfeed the infant even during infant’s illness. Reports in the literature have indicated that babies who are not exclusively breastfed are more likely to die from pneumonia compared to those babies who are exclusively breastfed.
Thus, exclusive breastfeeding is essential for the first six months of life of an infant, benefitting both mother and the child. We need to counsel mothers, caregivers about benefit and importance of exclusive breastfeeding and encourage and provide support to them. Governments, family members, and community health workers have an important role to play in the survival of newborns.