From Wikipedia, the free encyclopedia
An infant breastfeeding
International Breastfeeding Symbol
- Sucking and nursing are synonyms. For other
uses, see
Nursing (disambiguation)
Breastfeeding (or nursing[1])
is the feeding of an
infant or young
child
with
breast milk directly from human
breasts rather than from a
baby bottle or other container. Babies have a
sucking reflex that enables them to suck and swallow milk.
Most mothers can breastfeed for six months or more, without the
addition of
infant formula or solid food.
Human
breast milk is the most healthful form of milk for human
babies.[2]
There are few
exceptions, such as when the mother is taking certain
drugs
or is infected with
tuberculosis or
HIV.
Breastfeeding promotes health, helps to prevent disease and
reduces health care and feeding costs.[3]
In both
developing and
developed countries, artificial feeding is associated with
more deaths from
diarrhoea in infants.[4]Experts
agree that breastfeeding is beneficial, but may disagree about
the length of breastfeeding that is most beneficial, and about
the risks of using artificial formulas.[5][6][7]
Both the
World Health Organization (WHO) and the
American Academy of Pediatrics (AAP) recommend exclusive
breastfeeding for the first six months of life and then
breastfeeding up to two years or more (WHO) or at least one year
of breastfeeding in total (AAP). Exclusive breastfeeding for the
first six months of life "provides continuing protection against
diarrhea and respiratory tract infection" that is more common in
babies fed formula.
[8] The WHO[9]
and AAP[10]
both stress the value of breastfeeding for mothers and children.
While recognizing the superiority of breastfeeding, regulating
authorities also work to minimize the risks of artificial
feeding.[6]
According to a WHO 2001 report,[11]
alternatives to breastfeeding include:
The acceptability of
Breastfeeding in public varies by culture and country. In
Western culture, though most approve of breastfeeding, some
mothers may be reluctant to do so out of fear of public opinion.
Lactation
The production, secretion and ejection of milk is called
lactation. It is one of the defining features of being a
mammal.
Breast milk
Not all the properties of
breast milk are understood, but its
nutrient content is relatively stable. Breast milk is made
from nutrients in the mother's bloodstream and bodily stores.
Because breastfeeding uses an average of 500 calories a day it
helps the mother lose weight after giving birth.[12]
The composition of breast milk changes depending on how long the
baby nurses at each session, as well as on the age of the child.
Research shows that the milk and energy content of breastmilk
actually decreases after the first year.[9]
Breastmilk adapts to a toddler's developing system, providing
exactly the right amount of nutrition at exactly the right time.[10]]
In fact, research shows that between the ages of 12 and 24
months, 448 milliliters of human milk provide these percentages
of the following minimum daily requirements:[13]
| Energy: |
29% |
| Folate: |
76%% |
| Protein: |
43% |
| Vitamin B12: |
94% |
| Calcium: |
36% |
| Vitamin C: |
60% |
| Vitamin A: |
75% |
The quality of a mother's breast milk may be compromised by
stress, bad food habits, chronic illnesses, smoking, and
drinking.[14][unreliable
source?][15]
Benefits for the infant
Himba woman and child.
A woman with her child in
Kabala,
Sierra Leone in the 1960's.
During breastfeeding
nutrients and
antibodies pass to the baby[16]
while it helps to strengthen the
maternal bond.[17]
Research has found many benefits to breastfeeding.
[18] These include:
Superior nutrition
Breast milk has just the right amount of fat, sugar, water,
and protein that is needed for a baby's growth and development.[17]
Greater immune health
Breast milk contains several anti-infective
factors such as
bile salt stimulated lipase (protecting against
amoebic infections),
lactoferrin (which binds to iron and inhibits the growth of
intestinal bacteria)[19][20]
and
immunoglobulin A protecting against
microorganisms.[21]
As breastfeeding can transmit
HIV
from mother to child, UNAIDS recommends avoidance of all
breastfeeding where formula feeding is acceptable, feasible,
affordable and safe.[22]
The qualifications are important. Some constituents of breast
milk may protect from infection. High levels of certain
polyunsaturated fatty acids in breast milk (including
eicosadienoic,
arachidonic and
gamma-Linolenic acids) are associated with a reduced risk of
child infection when nursed by HIV-positive mothers. Arachidonic
acid and gamma-linolenic acid may also reduce
viral shedding of the HIV virus in Breast milk.[23]
Due to this, in underdeveloped nations infant mortality rates
are lower when HIV-positive mothers breastfeed their newborns
than when they use infant formula. However, differences in
infant mortality rates have not been reported in better
resourced areas.[24]
Treating infants prophylactically with Lamivudine can help to
decrease the transmission of HIV through mother to child.
[25]
Higher intelligence
Two initial studies suggest babies with a specific version of
the
FADS2 gene demonstrated an
IQ averaging 7 points higher if breastfed, compared with
babies with a less common version of the gene who showed no
improvement when breastfed. FADS2 affects the metabolism of
fatty acids, such as
DHA and
AA, which are known to be linked to early brain development.
Manufacturers of infant formula have been adding DHA and AA
fatty acids to their products since this discovery over a decade
ago. The researchers state, "further investigation to replicate
and explain this specific gene–environment interaction is
warranted," and have concluded, "Our findings support the idea
that the nutritional content of breast milk accounts for the
differences seen in human IQ. But it's not a simple all-or-none
connection: it depends to some extent on the genetic makeup of
each infant."[26]
Horwood, Darlow and Mogridge tested the
intelligence quotient scores of low
birthweight children at seven or eight years of age. Those
who were breastfed for more than eight months had significantly
higher intelligence quotient scores than comparable children
breastfed for less time. They concluded, "These findings add to
a growing body of evidence to suggest that breast milk feeding
may have small long term benefits for child cognitive
development."
[27]
Long term health effects
Infants exclusively breastfed have less chance of developing
diabetes mellitus type 1 than peers with a shorter duration
of breastfeeding and an earlier exposure to cow milk and solid
foods.[28]
Breastfeeding also appears to protect against
diabetes mellitus type 2,[29][30]
at least in part due to its effects on the child's weight.[30]
Breastfeeding appears to reduce the risk of extreme
obesity in children aged 39 to 42 months.[31]
The protective effect of breastfeeding against obesity is
consistent, though small, across many studies, and appears to
increase with the duration of breastfeeding.[32]
In one study, breastfeeding did not appear to offer
protection against
allergies.[dubious
–
discuss][33]
However, another study showed breastfeeding to have lowered the
risk of
asthma, protect against allergies[dubious
–
discuss], and provide improved
protection for babies against respiratory and intestinal
infections.[34]
A review of the association between breastfeeding and
celiac disease (CD) concluded that breast feeding while
introducing
gluten to the diet reduced the risk of CD. The study was
unable to determine if breastfeeding merely delayed symptoms or
offered life-long protection.[35]
A study at the University of Wisconsin found that women who
were breast fed in infancy may have a lower risk of developing
breast cancer than those who were not breast fed.
[36][unreliable
source?]
Fewer urinary tract, diarrheal and
middle ear infections
Breastfeeding reduced the risk of acquiring
urinary tract infections in infants up to seven months
of age. The protection was strongest immediately after
birth, but was ineffective past seven months[37]
Breastfeeding appears to reduce symptoms of
upper respiratory tract infections in premature infants up
to seven months after release from hospital.[38]
A longer period of breastfeeding is associated with a shorter
duration of some middle ear infections (otitis
media with effusion, OME) in the first two years of life.
The researches concluded, "For a decrease in the amount of time
with OME during the first 2 years of life, prolonged
breast-feeding and upright feeding position should be
encouraged, and cigarette smoke exposure should be minimized.
Limiting early child care in large groups might also be
advisable.".[39]
Another study found that breastfed babies had half the incidence
of diarrheal illness, 19% fewer cases of any
otitis media infection and 80% fewer prolonged cases of
otitis media than formula fed babies in the first twelve months
of life.[40]
Less tendency to develop allergic
diseases (atopy)
In children who are at risk for developing allergic diseases
(defined as at least one parent or sibling having
atopy),
atopic syndrome can be prevented or delayed through exclusive
breastfeeding for four months, though these benefits may not be
present after four months of age.
[41] However, the key factor may be the age at which
non-breastmilk is introduced rather than duration of
breastfeeding.[42]
Atopic dermatitis, the most common form of
eczema, can be reduced through exclusive breastfeeding
beyond 12 weeks in individuals with a family history of atopy,
but when breastfeeding beyond 12 weeks is combined with other
foods incidents of eczema rise irrespective of family history.[43]
Less necrotizing enterocolitis in
premature infants
Necrotizing enterocolitis (NEC), is an acute inflammatory
disease in the intestines of infants. Necrosis or death of
intestinal tissue may follow. It is mainly found in
premature births. In one study of 926 preterm infants, NEC
developed in 51 infants (5.5%). The death rate from necrotizing
enterocolitis was 26%. NEC was found to be six to ten times more
common in infants fed formula exclusively, and three times more
common in infants fed a mixture of breast milk and formula,
compared with exclusive breastfeeding. In infants born at more
than 30 weeks, NC was twenty times more common in infants fed
exclusively on formula.[44]
More easily aroused from sleep
Breastfed babies have better arousal from sleep at 2–3
months. This coincides with the peak incidence of
sudden infant death syndrome.[45]
Benefits for mothers
Breastfeeding is a cost effective way of feeding an infant,
and provides the best nourishment for a child at a small
nutrient cost to the mother. Frequent and exclusive
breastfeeding can delay the return of fertility through
lactational amenorrhea, though breastfeeding is an imperfect
means of
birth control. During breastfeeding beneficial
hormones are released into the mother's body.[16]
and the maternal bond can be strengthened.[17]
Breastfeeding is possible throughout
pregnancy, but generally milk production will be reduced at
some point.[46]
Long-term health effects
A recent study indicates long duration of lactation (at least
24 months) is associated with a reduced risk of heart disease in
women.[47]
Breastfeeding mothers also have less risk of
endometrial,[48][49]
and
ovarian cancer,[17][10]
and
osteoporosis,[17][10]
and breast cancer.
Mothers who breastfeed longer than eight months also benefit
from bone re-mineralisation[50]
and breastfeeding
diabetic mothers require less insulin.[51]
Breastfeeding helps stabilize maternal
endometriosis,[10]
reduces the risk of post-partum
bleeding[52]
and benefits the
insulin levels for mothers with
polycystic ovary syndrome.[53]
Women who breast feed for longer have less chance of getting
rheumatoid arthritis, a Malmo University study published online
ahead of print in the Annals of the Rheumatic Diseases suggested
(See
Women Who Breast Feed for More than a Year Halve Their Risk of
Rheumatoid Arthritis). The study also found that taking oral
contraceptives, which are suspected to protect against the
disease because they contain hormones that are raised in
pregnancy, did not have the same effect. Simply having children
but not breast feeding also did not seem to be protective.
Bonding
The hormones released during breastfeeding strengthen the
maternal bond. Teaching partners how to manage common
difficulties is associated with higher breastfeeding rates.[54]
Support for a mother while breastfeeding can assist in
familial bonds and help build a
paternal bond between father and child.[55]
If the mother is away, an alternative caregiver may be able
to feed the baby with expressed breast milk. The various
breast pumps available for sale and rent help working
mothers to feed their babies breast milk for as long as they
want. To be successful, the mother must produce and store enough
milk to feed the child for the time she is away, and the feeding
caregiver must be comfortable in handling breast milk.
Hormone release
Breastfeeding releases
oxytocin and
prolactin, hormones that relax the mother and make her feel
more nurturing toward her baby.[56]
Breastfeeding soon after giving birth increases the mother's
oxytocin levels, making her uterus contract more quickly and
reducing bleeding. Oxytocin is similar to pitocin, a synthetic
hormone used to make the uterus contract.[52]
Weight loss
As the fat accumulated during pregnancy is used to produce
milk, extended breastfeeding—at least 6 months—can help mothers
lose weight.[57]
However, weight loss is highly variable among lactating women,
and diet and exercise are more reliable ways of losing weight.[58]
Natural postpartum infertility
A breastfeeding woman may not
ovulate, or have regular periods, during the entire
lactation period. The period in which ovulation is absent
differs for each woman. This
Lactational amenorrhea has been used as an imperfect form of
natural contraception, with a greater than 98% effectiveness
during the first six months after birth if specific nursing
behaviors are followed.[59]
It is possible for some women to ovulate within two months after
birth while fully breastfeeding.
Organisational endorsements
World Health Organization
|
“ |
[the] vast
majority of mothers can and should breastfeed, just as
vast majority of infants can and should be breastfed.
Only under exceptional circumstances can a mother's milk
be considered as unsuitable for her infant. For those
few health situations where infants cannot, or should
not, be breastfed, the choice of the best alternative -
expressed milk from the infant's own mother, breast milk
from a healthy wet-nurse or a human-milk bank, or a
breast milk substitute fed with a cup, which is a safer
method than a feeding bottle or a teat - depends on
individual circumstances.
[60] |
” |
The WHO recommends at least two years of breastfeeding and
exclusive breastfeeding for the first six months of life.
Breastfeeding should continue after two years of life as long as
mutually desired by mother and child.
American Academy of Pediatrics
|
“ |
Extensive
research, especially in recent years, documents diverse
and compelling advantages to infants, mothers, families,
and society from breastfeeding and the use of human milk
for infant feeding. These include health, nutritional,
immunologic, developmental, psychological, social,
economic, and environmental benefits.[10] |
” |
AAP recommends at least one year of breastfeeding and
exclusive breastfeeding for the first six months of life.
Breastfeeding should continue after two years of life as long as
mutually desired by mother and child.
Breastfeeding difficulties
While breastfeeding is a natural human activity, difficulties
are not uncommon. Putting the baby to the breast as soon as
possible after the birth helps to avoid many problems. The AAP
breastfeeding policy says: Delay weighing, measuring,
bathing, needle-sticks, and eye prophylaxis until after the
first feeding is completed.[10]
Many breastfeeding difficulties can be resolved with proper
hospital procedures, properly trained midwives, doctors and
hospital staff, and lactation consultants.[61]
There are some situations in which breastfeeding may be harmful
to the infant, including infection with
HIV
and acute poisoning by environmental contaminants such as lead.[34]
Rarely, a mother may not be able to produce breastmilk because
of a prolactin deficiency. This may be caused by Sheehan's
syndrome, an uncommon result of a sudden drop in blood pressure
during childbirth typically due to hemorrhaging. In developed
countries, many working mothers do not breast feed their
children due to work pressures. For example, a mother may need
to schedule for frequent pumping breaks, and find a clean,
private and quiet place at work for pumping. These
inconveniences may cause mothers to give up on breast feeding
and use infant formula instead.
Infant weight gain
Breastfed infants generally gain weight according to the
following guidelines:
- 0–4 months: 170 grams per week†
- 4–6 months: 113–142 grams per week
- 6–12 months: 57–113 grams per week
- † It is acceptable for some babies to gain
113–142 grams (4–5 ounces) per week. This average is taken
from the lowest weight, not the birth weight.
The average breastfed baby doubles its birth weight in 5–6
months. By one year, a typical breastfed baby will weigh about
2½ times its birth weight. At one year, breastfed babies tend to
be leaner than bottle fed babies.[62]
By two years, differences in weight gain and growth between
breastfed and formula-fed babies are no longer evident.[63];
Methods and considerations
There are many books and videos to advise mothers about
breastfeeding.
Lactation consultants in hospitals or private practice, and
volunteer organisations of breastfeeding mothers such as
La Leche League also provide advice and support.
Early breastfeeding
In the half hour after birth, the baby's suckling reflex is
strongest, and the baby is more alert, so it is the ideal time
to start breastfeeding[64].
Early breast-feeding is associated with fewer nighttime feeding
problems
[65]
Time and place for breastfeeding
Breastfeeding at least every two to three hours helps to
maintain milk production. For most women, eight breastfeeding or
pumping sessions every 24 hours keeps their milk production
high.[10]
Newborn babies may feed more often than this: 10 to 12
breastfeeding sessions every 24 hours is common, and some may
even feed 18 times a day.[66]
Feeding a baby "on demand" (sometimes referred to as "on cue"),
means feeding when the baby shows signs of
hunger; feeding this way rather than by the clock helps to
maintain milk production and ensure the baby's needs for milk
and comfort are being met.[9]
However, it may be important to recognize whether a baby is
truly hungry, as breastfeeding too frequently may mean the child
receives a disproportionately high amount of foremilk, and not
enough hindmilk.[67].
"Experienced breastfeeding mothers learn that the sucking
patterns and needs of babies vary. While some infants' sucking
needs are met primarily during feedings, other babies may need
additional sucking at the breast soon after a feeding even
though they are not really hungry. Babies may also nurse when
they are lonely, frightened or in pain.[3]"
"Comforting and meeting sucking needs at the breast is
nature's original design. Pacifiers (dummies, soothers) are a
substitute for the mother when she can't be available. Other
reasons to pacify a baby primarily at the breast include
superior oral-facial development, prolonged lactational
amenorrhea, avoidance of nipple confusion and stimulation of an
adequate milk supply to ensure higher rates of breastfeeding
success.[4]"
Most US states now have laws that allow a mother to
breastfeed her baby anywhere she is allowed to be. In hospitals,
rooming-in care permits the baby to stay with the mother and
improves the ease of breastfeeding. Some commercial
establishments provide breastfeeding rooms, although laws
generally specify that mothers may breastfeed anywhere, without
requiring them to go to a special area.
Latching on, feeding and positioning
Correct positioning and technique for latching on can prevent
nipple soreness and allow the baby to obtain enough milk.
[68] The "rooting reflex" is the baby's natural
tendency to turn towards the breast with the mouth open wide;
mothers sometimes make use of this by gently stroking the baby's
cheek or lips with their nipple in order to induce the baby to
move into position for a breastfeeding session, then quickly
moving baby onto the breast while baby's mouth is wide open.
[69] In order to prevent nipple soreness and allow the
baby to get enough milk, a large part of the breast and areola
need to enter the baby's mouth.[68][70]
To help the baby
latch on well, tickle the baby's top lip with the nipple,
wait until the baby's mouth opens wide, then bring the baby up
towards the nipple quickly, so that the baby has a mouthful of
nipple and
areola. The nipple should be at the back of the baby's
throat, with the baby's tongue lying flat in its mouth.
Inverted or flat nipples can be massaged so that the baby
will have more to latch onto. Resist the temptation to move
towards the baby, as this can lead to poor attachment.
Initiation of Breastfeeding by Breast Crawl
