Nutrition In Infancy : Breast Feeding
Infants who are exclusively breast fed for the first 4-6 months of life grow well and breast feeding is beneficial not only during this period but also during later years of life. The infant is put on breast within half an hour after a normal delivery.
During first two or three days colostrum is secreted in small quantities of about 10-40 ml. The composition of colostrum is as follows:
Nutrient Quantity / 100 ml
Energy (k.cal) 58
Fat (g) 2.9
Calcium (mg) 31
Phosphorus (mg) 14
Iron (mg) 0.09
Protein (g) 2.7
Lactose (g) 5.3
Carotene (IU) 186
Vitamin A (IU) 296
Source : Guthrie A.H., Introductory Nutrition, Times Mirror/Mosby
Colostrum contains interferon like substance which has strong antiviral activity. It contains B12 binding protein making it unavailable for growth of E-coli and other bacteria. It also contains antibodies against viral infection. Enzymes lysozyme and peroxidase which promote cell maturation are found to be more in colostrum.
Advantages of breast feeding
Breast feeding is the simple and best method of feeding and has the following advantages
1. Nutritional factors
The composition of human milk is best suitable for infants. List shows a comparison of human milk, cow's milk and Buffalo's milk.
It is observed that in human milk the protein content is lower but the content of carbohydrate, namely lactose is higher. The fat content
Comparison of Human is comparatively less. This is advantageous to the infant as low protein reduces pressure on kidney to excrete extra nitrogen. Also the protein is present as lactalbumin which is better digested than protein in cow's milk.
Lactose provides natural sweetness and also helps in absorption of calcium and iron. Fat though less is highly emulsified and therefore better digested. Lipids in breast milk include unsaturated fatty acids, essential fatty acids, prostaglandin precursors, fat soluble vitamins, phospholipids and cholesterol.
milk with cow's and buffalo's milk
Nutrient Human milk Vs Cow's Milk VS Buffalo's Milk
Per 100 ml
Water (g) 88 87.5 81
Energy (k.cal) 65 67 117
Protein (g) 1.1 3.2 4.3
Carbohydrate (g) 7.4 4.4 5
Fat (g) 3.4 4.1 6.5
Calcium (mg) 28 120 210
Phosphorus (mg) 11 90 130
Iron (mg) -- 0.2 0.2
Carotene (mg) 137 174 160
Thiamine (mg) 0.02 0.05 0.04
Riboflavin (mg) 0.02 0.19 0.1
Vitamin C (mg) 3 2 1
Caseinogen lactalbumin ratio 1:2 3:1 -
When compared to animal milk, breast milk provides higher amount of vitamin C which is not destroyed by heating as it happens with cow's milk. The bioavailability of iron, in the presence of iron binding protein lactoferrin is higher. Similarly calcium in breast milk though less when compared to cow's milk is better absorbed by the infant.
2. Hormones and growth factors:
Breast milk is a rich source of hormones like Thyroid Stimulating Hormone (TSH), thyroxin, insulin and prolactin. It also contains growth regulating factors, growth promoters and growth modulators.
3. Immunological factors:
The following factors in breast milk provide passive immunity - that does not require the activation of the infants own immune defenses.
1. Macrophages: They can digest bacteria and also develop immunity against infectious diseases.
2. Lymphocytes: Lymphocytes produce antiviral substances like interferon. Lymphocytes also produce lymphokynes and other growth factors which stimulate proliferation and differentiation in the lymphoid tissue and its capacity to react to antigens.
3. Lactoferrin: It is an iron binding protein that inhibits the growth of E.Coli and other bacteria by binding the iron needed for their growth.
4. Lactobacillus bifidus factor: It is an amino sugar and contains N-acetyl neuraminic acid. It encourages the growth of the microorganism Lactobacillus bifidus and produces acetic acid or lactic acid from lactose and depresses the growth of pathogenic and disease causing organisms.
Enzymes: Breast milk also supplies enzymes like lipase, amylase and lactoperoxidase which increase digestibility and also destroy the harmful microorganisms.
Immunoglobulin: They are defensive proteins which include all types of antibodies. Immunoglobulin A is found in relatively high levels which offers protection against polio virus, streptococus and pneumococcus.
4. Economic factors
Breast milk is the most economical food for the baby. Even after accounting the extra food cost required by the mother, breast milk is cheaper than any other type of artificial feed.
5. Psychological factors
Breast feeding is essential for a healthy, happy and emotional relationship between the mother and the infant. While the mother gets a feeling of satisfaction, it gives a sense of security to the infant.
6. Natural contraceptive
During breast feeding there is a high level of protection, which prevents ovulation leading to lactational amenorrhea. This prevents the onset of another pregnancy due to suspension of menstruation and helps the uterus to return to its normal size. Breast feeding also prevents breast cancer.
7. Other advantages:
1. Infants jaw is more fully developed as he works harder to extract milk.
2. Breast milk is microbiologically sterile and hence less incidence of contamination and gastrointestinal problems.
3. Human milk is always fresh and at the right temperature.
4. It is convenient to administer at any time.
5. Low danger of incorrect formula or overfeeding.
6. Breast fed babies have better cognition and IQ later in life when compared to bottle fed babies.
In order to promote breast feeding and provide safe and adequate nutrition for the infant the Government of India has formulated the Indian National Code for protection and promotion of breast feeding. Subsequently the Infant Milk Substitute (IMS) act 1992 was passed to protect, promote and support breast feeding. According to this act there should be,
1. no promotion of infant feeding products
2. no display of artificial feeding products in health care facilitates
3. the company personnel should not contact mothers for marketing and
4. any brochures, booklets which advertise infant feeding products should not be permitted.
The World Alliance for Breast feeding Action (WABA) a network of organizations in collaboration with WHO and UNICEF, which also promote breast feeding, has declared August 1-7 as the world breast feeding week.
Though breast milk is the best milk and there can be no substitute for it, there are certain circumstances during which the infant need to be given artificial feeds.
Reasons related to mother
1. Illness of short duration like fever, cracked nipples or severe illness like tuberculosis, heart disease.
2. The mother is on steroids, anticoagulants or radioactive drugs.
3. Insufficient milk secretion.
Death of mother.
Reasons related to infant
1. Extreme prematurity.
2. Acute infections.
3. Congenital deformities like 'cleft palate' and gastrointestinal tract obstructions.
In the absence of breast milk, animal milk or toned milk is given as a substitute which need not be diluted but in cases when the infant is not able to digest, milk can be diluted using boiled water in the ratio of 3:1. When the baby is fed on animal milk, supplements of iron and vitamin C are essential.
Artificial milk formulae in dry form prepared from animal milk are available in the market which have been modified in nutrient content so as to resemble breast milk. These formulas are fortified with iron.
Whenever the infant is fed with an artificial food utmost care in handling and preparing the feed is essential. This includes cleanliness of utensils, bottles and nipples.