Breast feeding

Mother’s breast milk is the best form of nutrition for an infant (1).

• it provides babies with a complete source of nutrition needed for the first 6 months of life which includes fats, carbohydrates, proteins, vitamins, minerals as well as bioactive factors which provide short-term and long-term health and development benefits to the infant’s immature immune system
  • studies from developing countries show that infants who are not breastfed are 6 to 10 times more likely to die in the first months of life than infants who are breastfed with pneumonia and diarrhea being responsible for a majority
• for mothers, both short- and long-term health benefits of breastfeeding have been implicated e.g - reduced risk of post-partum haemorrhage, breast and ovarian cancer (2)

A variety of neurohormonal mechanisms facilitate breast feeding:

• during pregnancy - human placental lactogen, oestrogens and progesterone prepare the breasts for lactation.
• milk production - suckling stimulates the release of prolactin from the anterior pituitary gland. Prolactin is important in initiating milk secretion and in maintaining milk production after birth
• milk ejection - suckling stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is responsible for the ejection - let down - of milk by acting on the myeloepithelial cells that surround the alveoli and ductules (2).

The WHO recommends exclusive breast feeding (for the first 6 months (180 days) of an infant’s life with supplemental breast feeding continuing for two years and beyond (2).

• "Exclusive breastfeeding" is defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups (vitamins, minerals and medicines)
• introduction of complementary foods is recommended at the age of 6 months to fill the energy and nutrient gap caused by excessive nutritional requirements of infants
  • it is important to continue breastfeeding even after introduction of complementary foods since breast milk continues to supply higher quality nutrients than complementary foods, and also protective factors.
• mothers who are unable to follow these recommendations or those who choose not to do so, should be provided with the necessary support to optimize their infants nutrition (2).

Generally breastfeeding should be "on demand", as often as the child wants day and night e.g. - whenever the baby shows signs of hunger such as increased alertness, activity, mouthing, rooting or crying (2).

• babies feed with different frequencies, and take different amounts of milk at each feed
  • the 24 hour intake of milk varies between mother-infant pairs (from 440–1220 ml) but on average around 800 ml of milk is consumed per day throughout the first 6 months

The NICE committee note (3):

• "...the UK Scientific Advisory Committee on Nutrition (SACN), UNICEF and the World Health Organization recommend 6 months of exclusive breastfeeding, and continuing breastfeeding to their second year and beyond. The committee agreed that appropriate support before birth and during the first weeks after birth will enable continued breastfeeding for longer..."

Reference:

• (1) Anatolitou C. Human milk benefits and breastfeeding. Journal of Pediatric and Neonatal Individualized Medicine 2012;1(1):11-18
• (2) World Health Organization (WHO) 2009. Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals
• (3) NICE (January 2025). Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years)