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Saturday, August 7, 2010

WHO: Facts for Life: Supporting Breastfeeding

As a Breastfeeding Activist and Advocate (Yes, I'm a Lactivist) I talk about the World Health Organizations (WHO) breastfeeding recommendations all the time.  I'm sure that many of us can recite in our sleep:
"Exclusive Breastfeeding for the first 6 months of life and for Breastfeeding to continue for up to two years and beyond"
But what else does WHO have to say about breastfeeding? About the dangers of using Infant Formulas and the roll that advertising/marketing plays in the undermining of Breastfeeding?  I thought you'd never ask!  I went searching and I've found this:  The World Health Organizations Facts for Life booklet.  The Booklet covers topics such as pregnancy & childbirth, breastfeeding, early childhood development, and nutrition, but I've just focused on the Breastfeeding section here.  To read the entire pdf document please click HERE

*I'm sorry about the formatting, I've tried to fix it several times and, well, it hates me and refuses to be fixed.... by me anyway.*

Breastmilk alone is the best food and drink for an infant for the first six
months of life. No other food or drink, not even water, is usually needed
during this period.

Breastmilk is the best food a young child can have. It promotes optimal
growth and development and protects against illness. Breastmilk contains the
perfect balance of nutrients for a baby, unlike infant formula, powdered milk
or animal milk.
The baby does not need water or other drinks or foods (such as tea, juice,
sugar water, gripe water, rice water, other milks, formula or porridge) during
the first six months. Even in hot, dry climates, breastmilk fully meets a baby’s
need for fluids.
Breastmilk is easy for the baby to digest. A baby has difficulty digesting
animal milks, and formula is digested much more slowly than breastmilk.
Compared to other options, breastmilk nourishes the baby more efficiently.
Breastmilk protects against illness because it contains antibodies that transfer
the mother’s immunity or resistance to disease to the child. No other milks
contain these antibodies.
Giving a baby under 6 months of age any liquids or foods other than
breastmilk increases the risk of diarrhoea and other illnesses. Water and other
liquids or foods may be contaminated, which can cause diarrhoea.
A baby who takes water or other liquids or foods in the first six months
suckles less on the breast. This slows down breastmilk production.
If regular weighing shows that a breastfed baby under 6 months of age is not
growing well:
● The mother may need help to improve the way the baby takes the
breast into the mouth to ensure good attachment so the baby can suckle
● The baby may need more opportunities to breastfeed. The baby should
breastfeed on demand, day and night, at least eight times during a
24-hour period. The baby should be allowed to breastfeed until she or he
releases the breast and looks satisfied and sleepy. This shows that the
baby has had all she or he wants from that breast. The baby should then
be offered the other breast and may or may not want it. The baby should
be kept on the breast until she or he has finished suckling.
● A low-birthweight baby may need frequent pauses during breastfeeding.
● The baby may be ill and should be checked by a trained health worker.
● The baby may be getting water or other fluids, which can reduce the
intake of breastmilk. The mother may need guidance on how to reduce
and eliminate other fluids and to increase and give only breastmilk.
Feeding a baby only with breastmilk and on demand during the first six
months can help to delay the return of the mother’s menstruation. This may
help to delay the next pregnancy. However, there is some possibility – less
than 2 per cent – that a mother can become pregnant before her periods
return. This becomes increasingly likely after six months.

 Newborn babies should be given to the mother to hold immediately after
delivery. They should have skin-to-skin contact with the mother and begin
breastfeeding within one hour of birth.

Skin-to-skin contact and breastfeeding soon after birth stimulate production
of the mother’s breastmilk. Breastfeeding also helps the mother’s womb
contract, which reduces the risk of heavy bleeding or infection and helps to
expel the placenta (afterbirth).
Colostrum, the thick yellowish milk the mother produces in the first few
days after giving birth, is the perfect food for newborn babies. It is very
nutritious and full of antibodies that help protect the baby against infections.
Sometimes mothers are advised not to feed colostrum to their babies. This
advice is incorrect. Newborns benefit from colostrum.

The newborn needs no other food or drink while the mother’s milk supply is
coming in and breastfeeding is being fully established. Giving any other food
or drink may slow the production of milk. It can also increase the chance of
diarrhoea and other infections. The milk produced by the mother is nutritious
and the right amount for the newborn. The baby should breastfeed as often as
she or he wants.
A baby who has problems suckling in the first few days should be kept
close to the mother, offered the breast frequently, helped to take the breast
and given breastmilk expressed directly into the mouth or fed expressed
breastmilk from a clean cup (not from a bottle). The mother should receive
help to improve the baby’s attachment and suckling, and should also be
shown how to express breastmilk, if necessary.
A mother’s own milk is best for low-birthweight babies. However, not all
of these infants are able to feed from the breast in the first days of life. For
them, other options are available. In order of preference, they are: expressed
breastmilk (from the mother); donor breastmilk (only if the donor is HIV-tested
and the milk is correctly heat-treated); and infant formula. All of these should
be given by cup, spoon or paladai (a cup feeding device), or medical tubes
used by a trained health worker in a health facility.
Heat-treated breastmilk involves heating expressed breastmilk (enough for
one or two feeds) in a small pan or in a metal container standing in a pan of
water until it comes to a boil. The milk is then left to cool in a clean, covered
container before it is fed to the baby by cup. A trained health worker can
provide further guidance on expressing and heat-treating breastmilk.
It is best for the mother and her baby to stay together in the same room
immediately after birth. If a mother gives birth in a hospital or clinic, she is
entitled to have her baby near her, 24 hours a day. She should insist that no
formula or water be given to her baby if she is breastfeeding.

Almost every mother can breastfeed successfully. Breastfeeding the baby
frequently causes production of more milk. The baby should breastfeed at
least eight times daily, day and night, and on demand.

A mother’s breasts make as much milk as the baby wants. If the baby
suckles more, more milk is produced. Almost every mother can successfully
breastfeed and produce enough milk when:
● she breastfeeds exclusively
● the baby is in a good position and is well attached to the breast, with the
breast well in the baby’s mouth
● the baby feeds as often and for as long as she or he wants, including
during the night, and is kept on the breast until she or he has finished
suckling. The baby should finish feeding from one breast before being fed
from the other breast.
Holding the baby in a good position makes it easier for the baby to take the
breast well into the mouth and suckle.
Signs that the baby is in a good position for breastfeeding are:
● the baby’s head and body are in line
● the baby is close to the mother’s body
● the baby’s whole body is turned towards the mother
● the baby is relaxed, happy and suckling.
Holding the baby in a poor position can cause difficulties such as:
● sore and cracked nipples
● the baby does not receive enough milk
● the baby refuses to feed.
Signs that the baby is well attached:
● more of the dark skin around the mother’s nipple (areola) can be seen
above the baby’s mouth than below it
● the baby’s mouth is wide open
● the baby’s lower lip is turned outward
● the baby’s chin is touching the mother’s breast.
Signs that the baby is suckling well:
● the baby takes long, deep sucks
● the cheeks are round when suckling
● the baby releases the breast when finished.
Generally, the mother does not feel any pain in her breast when
From birth, the baby should breastfeed whenever she or he wants. A baby
should be fed on demand at least eight times in a 24-hour period, during
both the day and the night. If a newborn sleeps more than three hours after
breastfeeding, she or he may be gently awakened and offered the breast.
Crying is not a sign that the baby needs other foods or drinks. It normally
means the baby wants to be held and cuddled more, the baby’s diaper or
nappy needs changing, or the baby is too hot or cold. Some babies need
to suckle the breast for comfort. More suckling produces more breastmilk,
which helps satisfy the baby’s feeding needs. If the baby cries a lot and does
not settle after feeding and being cuddled, the mother may need additional
breastfeeding support or the baby might not be well. A trained health worker
should be consulted.
Using pacifiers, dummies or bottles can interfere with establishing
breastfeeding in the baby’s first months of life, as the sucking action for these
is different from suckling at the breast. The baby may become used to the
bottle teat or pacifier and refuse the breast. This may cause less suckling time
at the breast, which reduces milk production. Pacifiers and bottle teats may
become contaminated, increasing a baby’s risk of illness.
Mothers who fear they do not have enough breastmilk often give their babies
other food or drink in the first few months of life. This causes the baby to
suckle less often, so less breastmilk is produced. The mother will produce
more milk if she does not give the child other food or liquids and if she
breastfeeds often.
Mothers need to be reassured that they can feed their babies under 6 months
of age properly with breastmilk alone, and they need to be shown how to
do it. All mothers, especially those lacking the confidence to breastfeed,
need encouragement and support from the child’s father and their families,
neighbours, friends, health workers, employers and women’s organizations.
A mother who has undergone a Caesarean birth may require extra help to
begin breastfeeding her baby.
Skilled birth attendants can raise awareness and understanding about
the benefits of breastfeeding. They should support mothers to initiate and
continue breastfeeding and help fathers and other family members accept
breastfeeding as a natural and nutritious practice that protects the life of
the baby.

Breastfeeding helps protect babies and young children against dangerous
illnesses. It also creates a special bond between mother and child.

Breastmilk is a baby’s ‘first immunization’. It helps to protect against
diarrhoea, ear and chest infections, and other health problems. The protection
is greatest when breastmilk alone is given for the first six months and when
breastfeeding continues along with other foods well into the second year and
beyond. No other milks, foods or supplements can provide the protection
of breastmilk.
Breastfeeding helps a mother and baby form a close, loving relationship –
a process called bonding. The close contact and attention help infants feel
secure and loved, which is important for their growth and development.
The father and other family members can help by encouraging the mother
to rest quietly while she breastfeeds the baby. They can also make sure the
mother has enough nutritious food and help with household tasks and caring
for older children.

 Bottle feeding and giving a baby breastmilk substitutes such as infant
formula or animal milk can threaten the baby’s health and survival. If
a woman cannot breastfeed her infant, the baby can be fed expressed
breastmilk or, if necessary, a quality breastmilk substitute from an ordinary
clean cup.

Babies who do not receive breastmilk do not receive protection from illnesses
provided by the mother’s antibodies and other components that come in her
milk. These babies are more likely to get diarrhoea and respiratory and ear
infections. Diarrhoea and respiratory infections, such as pneumonia, can be
deadly in babies and young children.
Feeding the baby breastmilk substitutes can cause poor growth or illness if
(1) too much or too little water is added, (2) the water is not from a safe
source and/or (3) the bottles and teats are not cleaned properly. Powdered
breastmilk substitutes may contain harmful bacteria that can cause illness.
Studies suggest that children fed breastmilk substitutes, as compared to
breastfed children, are at greater risk of childhood obesity and some chronic
illnesses, such as heart disease, later in life.
Feeding the baby breastmilk substitutes can be expensive and particularly
risky if parents cannot afford to buy enough of a quality breastmilk substitute.
For example, to feed one baby for the first six months requires 20 kilograms
(about 40 tins) of infant formula. Trained health workers should inform all
parents considering the use of breastmilk substitutes about the costs.
If it is necessary to feed the baby with formula, it is important to boil clean
drinking water first and then add the hot water to the powdered formula. The
water should not be added after it has cooled down. The directions for mixing
should be carefully followed. This ensures that the right amounts of formula
and safe water are mixed and that the process is hygienic. Before giving the
formula to the baby, the mother, father or other caregiver must make sure it
is not too hot.

Animal milk and infant formula go bad if left at room temperature (around
20–25 degrees Celsius) for more than two hours. Breastmilk can be stored
for up to eight hours at room temperature without going bad. Of course, it is
better to safely store all types of milk in a clean, covered container, preferably
in a refrigerator.
Cup feeding is safer than bottle feeding because the cup can be easily cleaned
with soap and water. Cup feeding also provides some of the contact and
stimulation the baby needs, since the person has to hold the baby. Feeding
with a cup does not cause problems with suckling at the breast.
The best food for a baby who cannot be breastfed directly is milk expressed
from the mother’s breast, given from a clean, open cup. Even newborn
babies can be fed with an open cup. If it is necessary to feed a baby with
a nutritionally adequate breastmilk substitute, it should be fed to the baby
by cup.

A woman employed away from her home can continue to breastfeed her
child. She should breastfeed as often as possible when she is with the infant
and express her breastmilk when they are apart so that another caregiver can
feed it to the baby in a clean and safe way.

If a mother cannot be with her baby during working hours, she should
breastfeed often when they are together. With frequent breastfeeding, she will
continue to produce breastmilk.
If a woman cannot breastfeed at her workplace, she can express her milk
two or three times during the workday and refrigerate it or store it at room
temperature for up to eight hours in a clean, covered container. The expressed
milk can be given to the child by another caregiver from a clean cup.
Families and communities can encourage employers to provide paid
maternity leave, creches, and the time and a suitable place for women to
breastfeed or express and store their milk. The place should be clean, safe and
private. It should have clean water available for washing hands and utensils.

 After 6 months of age, when babies begin to eat foods, breastfeeding should
continue for up to two years and beyond because it is an important source of
nutrition, energy and protection from illness.

Breastmilk remains an important source of energy, protein and other
nutrients such as vitamin A and iron, even when babies begin to consume
additional foods after 6 months of age. Breastmilk helps protect a child
against disease for as long as the child breastfeeds.
It is recommended that a mother continue to breastfeed her child up to
two years and beyond – as long as she and the child wish to continue.
Breastfeeding can comfort a child who is upset and is an important source of
nourishment during a child’s illness.