Breast milk is the ideal food for neonates. It provides optimal nutrition for growth and protects against infection. The WHO and UNICEF recommend exclusive breastfeeding for the first 6 months, and continued breastfeeding for up to 2 years along with adequate complementary foods after 6 months. Breast milk contains factors that support brain development and immunity while being easily digestible. It provides protection against illness for both short term and long term health benefits. Proper positioning and attachment during breastfeeding are important for successful feeding.

1. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg

2. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
Breast milk - ideal food for neonate.
• Essential for normal growth and development of a baby.
• To ensure optimal child health, survival, nutrition and development, WHO and
UNICEF recommend initiating breastfeeding
• within one hour of birth,
• exclusive breastfeeding for the first 6 months,
• continued breastfeeding for 2 years or beyond,
• along with adequate and appropriate complementary feeding after 6 months of age.
• Exclusive breastfeeding for 6 months has a potential to reduce under-5 mortality
rate by 13% .

3. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
Properties of Breast Milk
• Breast milk contains 88% of water.
Immunological advantages :
• Lactoferrin – protects from E.coli infection
• Secretory IgA- predominant immunoglobulin
• Bifidus factor – protects from E.coli infection
• Bile salt stimulated lipase – protects against giardiasis

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Bioactive Factors:
Epidermal growth factor (EGF) & transforming growth factor β (TGF β) enhance the integrity
or maturity of gastrointestinal epithelium, decrease the risk of allergy in later life.
Nutritional Properties:
Nutritive Value: 65kcal/100ml ( almost similar to cow milk)
Carbohydrates: 6-7g/dl – higher compared to cow/buffalo milk.
Predominant carbohydrate is lactose.
LACTOSE
GLUCOSE +
GALACTOSE
LACTASE
GLUCOSE
Lactose helps in production of lactoferrin and helps in colonization of GI
tract by good bacteria like lactobacillus.

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• Fat : 3.4 g/dl – lesser compared to cow milk
Rich in polyunsaturated fatty acids (PUFA)
Eg: Arachidonic Acid (ARA), Docosahexaenoic Acid (DHA)
Favours brain growth.
• Protein : 1.1 g/dl – 3 times less compared to cow’s milk.. Quality of protein is superior.
They favour brain growth.
Amino acids promoting brain growth – Taurine, cysteine
(values per
100grams)
Buffalo Cow Human
Fat (g) 6.5 4.1 3.4
Protein (g) 4.3 3.2 1.1
Energy (kcal) 117 67 65

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Other Benefits of Breastfeeding
• Protection from illness/ infection: 14 times less likely to die of diarrhea and 4
times less likely to die of respiratory infection compared to a non breast fed
baby.
• Allergy : decreased risk of allergy
• Decreased risk of diabetes & heart disease in later life
• IQ: baby who is breastfed till the age of 2 years has a higher IQ compared to
baby who is not breastfed till the age of 2 years.

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Benefits for Mother
• Helps in uterine involution
• Decreased incidence of postpartum hemorrhage
• Lactational amenorrhea for around 6 months
• Decreased risk of carcinoma breast and ovary
• Shedding weight after pregnancy
Deficiencies in Breast Milk
Micronutrients Deficient :
• Vitamin K,
• Vit D,
• Vit B12 (found in pure vegan/ vegetarian families)
• Others: Iron (baby has enough iron stores from mother. So, routine iron
supplementation is not required).

8. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
Composition of Breast Milk
1.Colostrum : milk secreted in the first 3-4 days.
Thick yellowish with high fat content & immunoglobulins (IgA)
2.Transitional Milk : Milk secreted till 14days after birth.
Protein content and immunoglobulins decrease, fats and sugar content increase.
3.Mature Milk : After 14 days
Foremilk is rich in water. It satisfies the thirst in the child.
Hindmilk is rich in fat. It satisfies the satiety (hunger demand) of the child
4.Preterm Milk : Milk secreted by mother who has delivered a preterm baby contains more
sodium, iron, protein and calories (sugars)

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Maternal Reflexes
• Prolactin Reflex :
Prolactin helps in production of breast milk : galactopoiesis
Active at night time ( mother should not skip night feeds to maintain prolactin reflex)
• Oxytocin reflex :
Oxytocin acts on myoepithelial cells causing contraction.
Helps in ejection of milk : galactokinesis
Active at all time.
Reflexes

10. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
Neonatal Reflexes
Rooting Reflex
• When a newborn baby’s mouth touches the nipple at the start of breastfeeding,
newborn turns the mouth towards the stimulus.
• Helps in initiation of feeding.
Suckling and Swallowing Reflex
• When the nipple region touches the baby’s palate, baby starts the process of
sucking. Once the baby’s mouth gets filled with milk, swallowing reflex is activated,
and baby swallows the milk.
• Suck-swallow-breathe cycle during breastfeeding is for approximately 1 second.

11. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
Technique of Breastfeeding
Positioning
Position of the mother : The mother can assume any position that is comfortable to her and
the baby. Her back should be well supported and she should not be leaning on her baby.
Position of baby:
Make sure that baby is wrapped properly in a cloth.
i. Baby's whole body is supported, not just neck or shoulders.
ii. Baby's head and body are in one line without any twist in the neck.
iii. Baby's body is turned towards the mother (abdomens of the baby and the mother touching
each other).
iv. Baby's nose is at the level of the nipple.

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Problems in Breastfeeding
• Not enough milk
• Inverted nipples
• Sore nipple
• Breast engorgement
• Breast abscess
Contraindications of Breastfeeding
Absolute
• Galactosemia
• Mother on chemo/radiotherapy
Relative
Infections in mother-
• HIV (if the mother has taken antiretroviral treatment for <4 weeks or has not been diagnosed)
• Tuberculosis (if the mother is not on antitubercular treatment or has completed <2weeks of ATT).
• Herpes simplex and herpes zoster (if the mother has lesions on the breast.)
Covid infection in mother is not a contraindication for breastfeeding

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How Long to Breastfeed
• NEWBORNS: 5-10 min/breast, every 2-3hours.
• One month or More: 20-40min/breast, every 3-4hours.
• By 6 months: 20-40min/breast, 3-5 times a day.

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Attachment (Latching)
• After proper positioning, the baby's cheek is touched and that initiates rooting reflex.
• Allow the baby to open his mouth widely and at that point, the baby should be latched
onto the breast ensuring that the nipple and most of the areola are within baby's mouth.
• It is important that the baby is brought on the mother's breast and mother should not
lean onto baby.
Signs of Good Attachment
• The baby's mouth is wide open.
• Most of the nipple and areola in the mouth, only upper areola visible, not the lower one.
• The baby's chin touches the breast.
• The baby's lower lip is everted.

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Expressed Breast Milk (EBM)
• If a mother is not in a position to feed her baby (e.g. ill mother, preterm baby,
working mother, etc.), she should express her milk in a clean wide-mouthed
container and this milk should be fed to her baby.
• EBM can be stored at room temperature for 6-8 hours, in a refrigerator for 24 hours
and a freezer at -20°C for 3 months.

17. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
World Breastfeeding Week 1-7 August,2022
CURRENT SCENARIO IN INDIA
Cost of Inadequate Breastfeeding is too High to be Ignored!
• In India, breastfeeding is inadequate as only 55% of babies are exclusively breastfed.
• Between 0-6 months and 41% are able to begin breastfeeding within an hour of birth.
• The World Health Assembly has set a target to increase global exclusive breastfeeding
rate from 38% in 2012 to 50% in 2025 globally.
• To contribute to this goal, India has to achieve 65.7% exclusive breastfeeding rate by
2025 as per WHO.

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23. Published by – DrShubhangiLingwal, DrShubhangiJuyal,Dr Guneet Singh, Dr ShubhamGarg
REFERENCES
1. OP Ghai Essential Pediatrics 9th generation
2. K. Park PSM 25th edition
2. Marrow Edition 6
3. https://www.bpni.org
4. https://www.who.int
5. https://www.unicef.org