This document discusses infant feeding practices and breastfeeding. It begins with definitions of different infant feeding categories like exclusive breastfeeding, predominant breastfeeding, complementary feeding, and bottle feeding. It then covers principles of breastfeeding like initiating breastfeeding within 30 minutes of birth and exclusively breastfeeding for the first 6 months. The advantages of breastfeeding for both babies and mothers are provided. National breastfeeding practices and initiatives like the Baby Friendly Hospital Initiative (BFHI) are also summarized.

1. INFANT FEEDING PRACTICES
Presented by
Dr Ravi Prakash
Junior Resident-I
Department of Community Medicine
Katihar Medical College, Katihar
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2. Contents..
 Introduction
 Definition
 Principles
 Advantages & disadvantages
 Breast feeding practices
 BFHI
 BFPNI
 WHO indicators of breast feeding practices
 National guidelines on promotion of infant and young child
feeding (2004)
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3. Introduction
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The human breast consists of the
nipple, the areola and the soft
tissue (i.e. breast glandular tissue
and supporting tissue).
The breast tissue is composed of
the alveoli (the glands) which are
small sacs, made up of millions
of milk secreting cells.
This system of sinuses and ducts
are interspersed in the supporting
tissue which consists of fat and
connective tissue.

4. It is a beautiful process involving the mother and the child.
 Reflexes in the Baby-
They are rooting reflex, suckling reflex and swallowing
reflex.
 Reflexes in the Mother-
They are prolactin reflex and oxytocin reflex.
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5.  Factors Affecting the Reflexes-
• Physical: Pain and tenderness in the breast, sore nipple,
fever.
• Psychological: Anxiety, tension, depression, worries, etc.
• Social: Unwanted sex, illegitimate child, unfamiliar
environment, presence of strangers, etc.
• Others: Oral pills, short and hurried feeds, improper position
and technique, nipple confusion by the baby if pacifier or
bottle is offered.
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6. A good suckling
position. The breast is
stretched into a ‘teat’
in the baby’s mouth.
A poor sucking
position. The baby is
sucking only the
nipple, and the
tongue is held back in
the mouth.
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7.  Signs of Good Attachment-
• Baby’s chin is close to the breast.
• Baby’s tongue is under the lactiferous sinuses and nipple
against the palate. Baby’s mouth is wide open and the lower
lip turned outwards.
• More areola is visible above the baby’s mouth than below it.
• No pain while breastfeeding.
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8.  Signs of Poor Attachment-
• Baby sucks only at the nipple.
• Mouth is not wide open, and much of the areola and thus
lactiferous sinuses are outside the mouth.
• Baby’s tongue is also inside the mouth and does not cup over the
breast tissue.
• Chin is away from the breast.
• It is painful while breastfeeding.
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9.  Right technique of Feeding in a Right Position of the Child is
the Key to the Success of Breastfeeding.
 Mother should feed the child 10 to 15 times a day, including.
 3 to 4 feedings during night times. Frequent sucking by the
child not only stimulates milk production and milk flow but
also prevents engorgement of breasts.
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10. Definitions
Category of
infant feeding
Requires that the
infant receive
Allows the infant to
receive
Does not
allow the
infant to
receive
Exclusive
breastfeeding
Breast milk including
milk expressed or
from wet nurse
Drops, syrups(vitamins,
minerals, medicines)
Anything else
Predominant
breastfeeding
Breast milk including
milk expressed or
from wet nurse as a
predominant source
Liquid ( water and water
based drinks, fruit juice,
ORS ), ritual fluids and
drops, syrups(vitamins,
minerals, medicines)
Anything else
(in particular,
non-human
milk, food
based fluids)
Complementar
y feeding
Breast milk and solid
or semisolid food
Any food or liquid including
non-human milk
-
Breastfeeding Breast milk Any food or liquid including
non-human milk
-
Bottle feeding Any liquid or semi-
solid food from a
bottle with nipple/teat
Any food or liquid including
non-human milk. Also
allows breast milk by bottle
-
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11. Principles of Breastfeeding
 Breastfeeding to be initiated within half an hour of birth,
because the newborn is very active during the first hour
of life and therefore the reflexes are strong.
 Early initiation also ensures that the baby gets colostrum
positively.
 Prelacteal feeds (like honey, sugar water, etc.
mentioned above) are strictly prohibited because not
only they introduce infection but also they replace
colostrum and interfere with sucking.
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12.  Exclusive breastfeeding should be given for first six months
of life.
 Complimentary feeding, to be started from 6th month
onwards only.
 However breastfeeding to be continued for at least 2 years.
 Bottle feeding and pacifiers are strictly prohibited to avoid
nipple confusion and infection (As a result of nipple
confusion the child will refuse to take breastfeeding)
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13. Merits of Breastfeeding
Advantages to the Baby
 Mother’s milk is the most complete food available in the
nature (because it provides all the nutrients).
 All the nutrients are present in the definite proportions.
 The nature of the nutrients are such that they are easily
digestible and assimilable.
 Other than the nutrients, it also contains hormones,
enzymes, protective antibodies (i.e. anti-infective factors).
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14.  It also contains other protective substances such as
leucocytes (lymphocytes and macrophages) which fight
infection, lactoferrin which binds iron and prevents the growth
of those pathogens which need iron, lysozyme which
destroys pathogens and bifidus factor which helps
Lactobacillus bifidus to grow in the intestine, which in turn
prevents the growth of pathogens causing diarrhea.
 It is bacteriologically clean and pure (hygienic).
 It is obtained easily, freely, all the 24 hours and at a suitable
temperature (cost effective).
 It improves the intelligent quotient (IQ) of the child and better
visual acuity due to the presence of special fatty acids.
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15.  It prevents or postpones the onset of diseases like diabetes,
cancer and hypertension.
 Anti-infective factors protect the child against respiratory,
alimentary diseases and also allergies, eczema and asthma.
 Exercise while sucking helps not only in the development of
jaws but also gives the child chubby-cheek appearance.
 It prevents obesity in the child.
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16. Advantages of the Mother
 Exclusive breastfeeding is a natural contraceptive method.
 It prevents cancer of the breast.
 It acts as an ‘anti-diabetogenic factor’, by reducing the
requirement of insulin among diabetic mothers.
 It helps in restoration of original physique.
 It helps in quick and early involution of uterus and reduces
postpartum bleeding.
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17. Advantages to the Family and Nation
 Saves money, time, conserves energy and reduces infant morbidity and
mortality. Therefore, it is an universal truth that breastfeeding is….
 It is the ‘best start’ to life.
 It is ‘unique’ & provides ‘umpteen number of benefits’ to both mother and
the child.
 It is the ‘gold standard’ of infant feeding, as it is safe, sound and
sustainable.
 It is the ‘foundation’ for fulfilling the rights of the child.
 It is ‘species specific’ and ‘eco-friendly’. Therefore breastfeeding is the best
feeding.
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18. Dangers of Artificial Feeding
 In the child: Infections, malnutrition, allergy, risk of chronic
diseases, obesity, low intelligent quotient.
 In the mother: Frequent pregnancy, risk of anemia, ovarian
and breast cancer.
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19. Breastfeeding practices
1. Breastfeeding Inititaion-
 Lifeline for newborn babies.
 Should started immediately after birth.
 Only 23.4% of newborn babies were put on breastfeeding
within one hour of birth.
 Only 37% of mothers initiated breastfeeding within one day.
 Nearly 2/3rd of women (63%) squeezed the first milk i.e.
discarded colostrum before they began
breastfeeding(NFHS-2).
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20. 2. Exclusive breastfeeding-
 Only 44.6% of mother initiated breastfeeding within one
hour of birth.
 In India 64 % of children till 6 month of age were exclusively
breastfed and the remaining children 36% received
breastfeeding plus fluid and supplementary feeds. (NFHS-3)
3. Bottle feeding-
 Prevalent in 16% of mothers
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21. 4. Breastfeeding to Low Birth Weight Baby
 Breastfeeding to a preterm baby is a special challenge. First
few days it may not be able to suck.
 Expressed breast milk should be given by nasogastric tube
feeding even in Kangaroo position. Tube feeding is
continued till it reaches 30 to 32 weeks of gestational age.
Then if it cannot suck, it is fed with spoon and a cup. After
feeding it can be returned to Kangaroo position again. After
32 weeks of gestational age, babies are usually able to
suck.
 If a LBW baby is able to suck, Kangaroo position is ideal for
breastfeeding. Mother should be encouraged to ensure
correct position and attachment.
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22. 5. New Pregnancy During Lactation
 Usually the mother stops feeding the child
suddenly, which has got an adverse effect on the
child. She is advised to continue to feed the child
till delivery and after delivery, she can feed both
the children. This is called ‘Tandem nursing’.
 However, sometimes she may get uterine colic or
bleeding per vagina. Under such circumstances
she can stop feeding.
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23. Baby Friendly Hospital Initiative
 Baby friendly hospital initiative (BFHI) is global
movement, developed jointly by WHO and
UNICEF in 1992. The word ‘Friendly’ implies
cardinality and warmth.
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24. Aim-
 To ensure that every newborn baby gets the best start in its life.
 To encourage correct scientific practices in breastfeeding.
Objectives-
 To protect, to promote and to support breastfeeding
Practices.
 To reduce infant mortality rate.
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25.  Criteria for Recognition of the Hospital as
‘Baby Friendly’
 Baby friendly hospital initiative (BFHI) has listed ten steps to
be fulfilled by the maternity hospitals for their recognition as
‘Baby Friendly’ hospitals.
1. Have a written breastfeeding policy to be communicated to
all health care staff.
2. Train all the health care staff in the skills necessary to
implement this policy.
3. Inform all the pregnant women about the benefits and
management of breastfeeding.
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26. 4. Help mothers to initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation when
they are separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless
medically indicated.
7. Practice ‘Rooming-in’. Allow mothers and infants to stay together 24
hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats, pacifiers, dummies or soothers to breastfeeding
infants.
10. Help start the establishment of breastfeeding support groups and refer
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27.  Benefits to the Hospitals-
 Professional satisfaction of helping lactating mothers.
 Infant mortality rate will come down.
 Hospitals get National and International recognition
without any financial investment.
 Hospital will be kept on a global forefront.
 Baby friendly hospital initiative (BFHI) has proved highly
successful in encouraging proper infant feeding practices.
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28. Breastfeeding Promotion Network of
India
 Breastfeeding promotion network of India (BPNI) is a
registered, independent, nonprofit, national organization
located at Delhi, that has been working toward protecting,
promoting and supporting breastfeeding and appropriate
complementary feeding of infants and young children.
 BPNI believes that breastfeeding is the right of all mothers
and children.
 BPNI works through advocacy, social mobilization,
information sharing, education, research, training and
monitoring the company compliance with the IMS Act.
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29. Goals-
 The main goal of BPNI is to empower all lactating women to
practice exclusive breastfeeding for the first six months of
infancy and continue breastfeeding up to 2 years or beyond
along with adequate and appropriate complimentary
feeding, starting after 6 months.
 BPNI also works in close liaison with International Baby
Food Action Network (IBFAN) and World Alliance for
Breastfeeding Action (WABA).
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30. IMS-Act
 Infant milk substitutes, feeding bottles and infant foods
(Regulation of production, supply and distribution) Act,
1992.
 In India, for about 27 million children born each year, about
1.9 million die before they see their first birth day and
around 2.5 million die by the time they are five years.
 India has the highest number of under five child deaths in
the world.
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31.  In May 1982, World Health Assembly adopted an
International Code for marketing of baby foods.
 Government of India recognized the code and adopted
Indian National Code for protection and promotion of
breastfeeding in December 1983.
 Finally, ‘The Infant Milk Substitutes (IMS), Feeding bottles
(FB) and Infant foods (IF) (Regulation of production, supply
and distribution) Act 1992 came into force on August 1, 1993
along with the rules.
 It was further strengthened in June 2003.
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32. The Act Prohibits
 Advertising to public about commercial baby foods
 Free samples to mothers
 Promotion in hospitals
 Gifts or samples to health workers
 Financial inducement to any person to promote the sales of such
foods
 Commission on sales to employees
 Payment of any kind to a health worker, working for the sales of such
foods.
Penalty
• Violation of the Act can lead to fine up to 5,000/- or
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33. Following voluntary organizations have been notified by
the Govt. of India to make a written complaint to the
court of law:
 Association for Consumers Action on Safety and Health
(ACASH), Mumbai.
 Indian Council for Child Welfare (ICCW), New Delhi.
 Central Social Welfare Board (CSWB), New Delhi.
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34. WHO indicators of breastfeeding practices
 Exclusive breastfeeding rate
 Timely complementary feeding rate
 Continued feeding rate
 Bottle feeding rate
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35. HIV and breastfeeding
 Incidence of mother to baby transmission of HIV through
breastfeeding estimates that risk is only 12-14%
 All mothers with HIV/AIDS should be explained with this risk
and decision after informed choices should rest with the
mother.
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36. National guidelines on promotion of infant
and young child feeding (2004)
 Early initiation of breastfeeding within half an hour of birth
Feeding of colostrum.
 Exclusive breastfeeding for the first half 6 months.
 Introduction of complementary feeding at 6 month of age.
 Staple cereal of the family should be used to make the first
food for infant.
 Encourage time tested traditional food like khichadi, dalia,
kheer, upma, dokhla etc.
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37.  Infant and young child should be fed 5-6 times/day.
 Continued breastfeeding upto age of two years or beyond.
 Appropriate feeding during and after the illness.
 HIV positive mothers should receive counselling on risk and
benefits of various feeding options. (absolute risk of HIV
transmission through breastfeeding for more than one year is 10-20%)
 Growth monitoring and promotion.
 Feeding in difficult circumstances.
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38. References
 Park’s Text book of Preventive & Social Medicine.
 Community medicine with Recent advances by
A.H.Suryakantha
 Textbook of Community Medicine by Sunder Lal,
Adarsh, Pankaj.
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