Why it is important to share and act on this information
Babies who are breastfed are generally healthier and achieve optimal growth
and development compared to those who are fed formula milk.
If the vast majority of babies were exclusively fed breastmilk in their
first six months of life – meaning
only breastmilk and no other liquids
or solids, not even water – it is estimated that the lives of at least 1.2
million children would be saved every year. If children continue to be
breastfed up to two years and beyond, the health and development of millions of
children would be greatly improved.
Infants who are not breastfed are at an increased risk of illness that can
compromise their growth and raise the risk of death or disability. Breastfed
babies receive protection from illnesses through the mother's milk.
Breastfeeding is the natural and recommended way of feeding all infants,
even when artificial feeding is affordable, clean water is available, and good
hygienic conditions for preparing and feeding infant formula exist.
If a mother is HIV-positive, there is a risk that she can transmit HIV to
her baby through breastfeeding. Counselling can help her carefully weigh the
risks and make an informed decision on which feeding option is best for her
baby and most manageable for her.
Almost every mother can breastfeed successfully. All mothers, particularly
those who might lack the confidence to breastfeed, need the encouragement and
practical support of the baby's father and their families, friends and
relatives. Health workers, community workers, women's organizations and
employers can also provide support.
Everyone has the right to information about the benefits of breastfeeding
and the risks of artificial feeding. Governments have a responsibility to
provide this information. Communities as well as media and other channels of
communication can play a key role in promoting breastfeeding.
Key Messages: What every family and community has a right to know
Supporting Information
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 effectively.
- 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.
Supporting Information
2.
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.
Supporting Information
3.
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
breastfeeding.
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.
Supporting Information
4.
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.
Supporting Information
5.
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.
Supporting Information
6.
If a woman is infected with HIV, there is a risk that she can pass the
infection to her infant through breastfeeding. In the first six months, this
risk is much greater if the infant is fed both breastmilk and other liquids and
foods than if fed breastmilk alone.
Therefore, it is recommended that the baby receives breastmilk alone for the first six months, unless it is
acceptable, feasible, affordable, sustainable and safe to give breastmilk
substitutes (infant formula) exclusively.
HIV testing, treatment and counselling
Pregnant women and new mothers who think they may be infected with HIV
should consult a trained health worker for HIV testing and counselling. Women
who are HIV-positive should be counselled on how to reduce the risk of passing
HIV to their children during pregnancy, childbirth or breastfeeding. They
should also be counselled and supported on how to get treatment and care for
themselves.
A trained health worker can provide women who are HIV-positive with
information on antiretroviral therapy (ART), a group of medicines for people
with HIV infection. ART can help reduce the risk of mother-to-child
transmission of HIV and contribute to keeping the mother healthy.
All health workers should know if HIV testing and ART are available at their
local clinic. They should provide information on these and other related
services to pregnant women and new mothers.
Assess the risks and determine what is manageable
The HIV-positive mother should be counselled and provided with information
to help her decide which feeding option is best for her baby and most
manageable for her. The HIV-positive mother should know that:
- if she breastfeeds
exclusively during the first six months she reduces the baby's risk of
illness, malnutrition and death
- if she uses breastmilk
substitutes such as infant formula exclusively she avoids the risk of HIV
infection through breastmilk
- shortening the duration of
breastfeeding can reduce the risk of transmitting the infection to the
infant.
The most appropriate infant feeding option for the child of an HIV-infected
mother ultimately depends on individual circumstances. The mother needs to
assess the risks through discussion with a trained health worker. The mother
infected with HIV has the right to: 1) the information she needs to make an
informed decision and 2) all the services and support necessary to help her
implement that decision.
Infant Feeding Options
The first six months:
- Feeding the baby with infant
formula (breastmilk substitutes) should be considered only if it is
acceptable, affordable, feasible, sustainable and safe for the mother and
child. If all these conditions can be met, the baby can be fed a quality
breastmilk substitute alone for the first six months, with no
breastmilk or other foods. This eliminates the risk of passing HIV to the
baby through breastfeeding.
- If the HIV-positive mother
decides to breastfeed, she should feed her baby breastmilk exclusively,
giving no other liquids, milks or foods, for the first six months. Feeding
breastmilk alone in the first six months can reduce a baby's risk
of HIV infection compared to giving both breastmilk and other foods and
liquids ('mixed feeding').
- Mixed feeding not only
greatly increases the risk of transmitting HIV to the baby in the first
six months but also causes more illness, such as diarrhoea and pneumonia,
and malnutrition, and increases the risk of death.
After six months:
- All infants should be
started on other foods to meet their growing nutritional needs.
- Women who have breastfed
their infants during the first six months should continue to give their
babies breastmilk along with other foods unless they meet the conditions
to give safe replacement foods, including infant formula and other milks
and foods. Once a nutritionally adequate and safe diet can be provided,
all breastfeeding should stop.
Other Important Information
During counselling, a pregnant woman or new mother with HIV can be helped to
determine whether she can provide her baby with a nutritionally adequate and
safe diet without breastmilk. This assessment should be undertaken not only
once, such as before the child is born, but also throughout the period of
breastfeeding, with the support of the trained health worker.
If the mother is confident that she can provide sufficient amounts of a
quality breastmilk substitute, properly and hygienically prepared with clean
water, then she can opt to stop all breastfeeding and begin using the
breastmilk substitute. A trained health worker should provide the mother and
father with guidance on safe and clean practices to prepare the breastmilk
substitute.
A new mother who does not know her HIV status should exclusively breastfeed
her child for the first six months and continue breastfeeding for up to two
years and beyond in addition to feeding the child other nutritious foods and
drinks.
Infants confirmed as HIV-positive should be breastfed so they can receive
the benefits of breastmilk.
(
Refer to the HIV chapter
for more information on children and families living with HIV.)
Supporting Information
7.
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, crèches, 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.
Supporting Information
8.
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.
