Breastfeeding is the ideal method of infant feeding for the first six months. It provides optimal nutrition through components in colostrum and breastmilk that enhance infant development and provide immunity. Proper breastfeeding techniques should be demonstrated to ensure babies feed effectively. The Baby-Friendly Hospital Initiative promotes ten evidence-based steps to support successful breastfeeding. Growth monitoring at under-five clinics helps identify malnutrition so it can be addressed, improving child health outcomes.

1. Infant Feeding

2. • Breast feeding:
• Reflexes in baby- rooting, sucking, swallowing
• Reflexes in mother- prolactin (milk production), oxytocin (milk
ejection)
• After birth, breast feeding should be initiated as early as possible
(within 1 hour) .The baby should be fed on demand. The mother
SHOULD NOT Force the baby to feed. ● Interrupt a feed before
the baby is done ● Use the artificial teats or pacifiers ● Give the
baby any other food or drink for the 1 st six months of life.
• Colostrum : During the first few days after delivery a woman
produces special milk that is thick, sticky and yellowish or clear in
colour. Colostrum contains large quantities of protective
substances, growth factors , has more protein-Vitamins A and K
than mature milk. It enhances the development and maturation
of the baby’s gastro-intestinal tract.

3. • The anti-infective proteins and white cells provide the first
immunization against the diseases. Colostrum is secreted in
small quantities (30-90 ml), it is sufficient to meet the caloric
needs of a normal newborn in the first few days of life.
• Colostrum also has a mild purgative effect, which helps to
clear baby’s gut of meconium and helps to prevent jaundice
by clearing the bilirubin from the gut. It stimulates the baby’s
immature intestine to develop in order to digest and absorb
milk and to prevent the absorption of undigested protein.
• “Exclusive breast feeding of the first six months of life”
• Benefits: Ideal method of infant feeding. It is the single most
cost effective intervention for reduction of infant mortality.
Delays return to fertility in the mother and hence acts as a
natural contraceptive

4. • Weaning (Complementary Feeding) : The complementary feeding
means giving the child other nutritious foods in addition to breast
milk. Weaning literally meant taking the child away from the
breast and nourishment by other means. Breast feeding alone is
sufficient to take care of the requirements in 1st six months.
Thereafter, concentrated energy dense complementary foods are
essential to maintain adequate velocity of growth for the infant.
Weaning if not carried out properly, may lead to malnutrition and
illness.
• The BFHI promotes, protects, and supports breast feeding
through The Ten Steps to Successful Breast feeding for Hospitals,
as outlined by UNICEF/ WHO in 1992
• Aim- ensure every newborn gets best start in its life and To
encourage scientific practices in breast feeding
• Objectives- reduce IMR and to promotes, protects, and supports
breast feeding

5. BFHI : Ten steps to successful breast feeding
• 1. Maintain a written breast feeding policy that is routinely
communicated to all health care staff
• 2. Train all health care staff in skills necessary to implement this policy.
• 3. Inform all pregnant women about the benefits and management of
breast feeding
• 4. Help mothers initiate breast feeding within 1 hour of birth.
• 5. Show mothers how to breast feed and how to maintain lactation,
even if they are separated from their infants.
• 6. Give infants no food or drink other than breast milk
• 7. Practice “rooming in”-- allow mothers and infants to remain together
24 hours a day.
• 8 Encourage unrestricted breast feeding
• 9. Give no pacifiers or artificial nipples to breast feeding infants
• 10. Foster the establishment of breast feeding support groups and refer
mothers to them on discharge from the hospital or clinic

6. Under Five’s Clinic
• Dr. Morley focuses role of growth monitoring through under-fives
clinic to quickly identify and combat malnutrition. The concept of ‘Well
Baby clinics emphasis on preventive services mainly immunization and
promotive growth monitoring.
• Under Fives - A special group constitute about 15 % of the total
population, suffer high rates of mortality and morbidity, effects of
malnutrition and other diseases have a role in later life, majority of the
deaths are preventable, this is a period of growth and development.
Brain growth is completed during 1st five years. Most causes of
morbidity are preventable by immunization. Health of children under
five years and family health are inter-related.

7. Causes of U5 Mortality

8. Goal- is to provide comprehensive health care to young children
in a specialized facility.
Objectives: 1. Care in illness , 2. Growth monitoring
3. Preventive care , 4. Family Planning , 5. Health education

9. • Functions
• (a) Care in Illness : fever, diarrhoea, ARI, infections of the skin
and helminthiasis. Essential laboratory investigations and
effective referral mechanism.
• (b) Growth Monitoring : child is weighed periodically – every
month during the first year, every 2 monthly from 1 to 3 years of
age and every 3 monthly in 4th and 5th years. Measuring height,
mid arm circumference carried out. Growth chart prepared. The
milestones are also recorded
• (c) Preventive Care : Immunization services during the 1st five
years of life, vitamin A & Iron supplementation and anti-
helminthic treatment to prevent anaemia, regular health check
up, nutritional surveillance and use of ORS during Diarrhoea.
• (d) Family Planning : Family planning is central to any program
directed towards women and children. The mothers are more
receptive to family planning during early Puerperium and
lactation. Mother is counselled for various options
• (e) Health Education : educate the mother on issues of child
care, breast feeding, nutrition, growth monitoring, immunization
and hygiene of safe water and food preparation.