Background
Appropriate nutritional
practices play a pivotal role in determining optimal health and development
of infants concerned by the lack of uniform guidelines for appropriate
infant feeding practces in the India context, the IAP Subspeciality
Chapter on Nutrition conducted a Workshop to define a policy on Infant
Feeding (Appendix). Subsequently, these recommendations were endoresed
as the official Indian Academy of Pediatrics Policy on Infant Feeding
and as National Guidelines on Infant Feeding by the Food and Nutrition
Board, Department of Women and Child Development, Ministry of Human
Resource Development, Government of India.
Contents of
theIAP Policy on Infant Feeding
Indeal infant feeding comprises exclusive breastfeeding for 4 to 6
months followed by sequential addition of semi-solid and solid foods
to complement (not replace) breastmilk till the child is gradually
abe to eat normal family food (around one year). The latter period
is also referred to as weaning. The term weaning doed not denote termination
of breastfeeding. Appropriate feeding is crucial for the healthy growth
and development of the infant. However, lack of confidence and widespread
ignorance and misconceptions frequently result in improper management
of infant feeding. The prominent areas of concern include discarding
or minimal feeding of colostrum or delayed iniitation of breastfeeding
by nearly 80% of mothers, non exclusive breastfeeding by 85-90% in
the first four months of life, unnecessary utilization of commercial
infant milk foods and animal milks and premature or delayed introduction
of semi-solids which may be contaminated, low in caloric density and
fed less frequently. These inept feeding practices, directly or indirectly,
contribute substantially to infectious illnesses, malnutrition and
mortality in infants. The Policy on Infant Feeding aims at promotion
of suitable practices to advance child care, growth and development,
reduce the prevalence of protein energy malnutrition (PEM), Vitamin
A deficiency and infectious disease, particularly diarrhea, and improve
survival. The Policy focuses on the strategy of educating and motivating
the families to adopt proper infant feeding methods through the existing
health infrastructure and other development programmes for women and
children.
- Appropriate Infant Feeding
Practices
-
- Breastfeeding
- Advantages of Breastfeeding
It is a proven scientific fact that all commerical infant
milk foods and animal milks are inferior to breasmilk:
(1) Maternal milk is nutritious food for infants to feed,
hygienic, develops emotional bonding and prevents allergic
disorders; (ii) Breastfeeding protects against several
infections including diarrhea and respiratory infections,
and saves lives. An exclusively breastfed infant is about
14 times less likely to die from diarrhea, 3 to 4 times
less likely to die from respiratory disease and 2 to 3
times less likely to die from other infections than a
non breastfed infant; (iii) Breast milk is much more economical
than artificial milk or powdered milk food - the average
cost of feeding a 6 month old infant for one month on
infant formula may even be equal to the average monthly
per capita income; (iv) "Exclusive" breastfeeding exerts
strong contraceptive effect in the first 4-6 months post
partum; (v) Maternal benefits include earlier termination
of post partum bleeding and protective effect against
breast and ovarian cancer.
- Preparation for Breastfeeding
During Pregnancy
The expectant mothers, particularly primiparas and those
experiencing difficulties with lactation management earlier,
should be motivated and prepared to exclusivelybreastfeed.
This should be achieved by educating, through a personal
approach, about the benefits and management of breastfeeding.
In the last trimester of pregnancy, breast and nipples
should be examined and relevant advise given. Expectant
mothers should be counseled to eat an extra green vegetables.
Additioanal rest of half to one hour and wherever possible,
switching to relatively lighter work during the last trimester
should be propagated.
- Starting Breastfeeds.
Practically all mothers, including those with mild to
moderate chronic malnutritions, can successfully breastfeed.
Soon after delivery, the mother should be allowed to keep
the newborn with her (rooming-in). After a normal delivery,
babaies should receive the first breeastfeed as soon as
possible an preferably within one hour of birth. During
this period and later, the normal newborn should not be
given any other fluid or food like honey, "ghutti", animal
or powdered milk, tea, water, glucose water etc. since
these are potentially harmful. It is essential that the
baby gets the first breastmilk called colostrum which
is thicker and yellower than later milk and comes only
in small amounts in the first few days. Colostrum is all
the food and fluid needed at this time - no supplements
are necessary, not even water. The mother, especially
with the first birth, may need help in the proper positioning
for breastfeeding. Breastfeeds should be given as often
as the baby desires and each feed should continue foe
as long as the infant wants to suckle. After a cesarean
section, breaftfeeding should be started as soon as possible
and preferably within 24 hours of delivery. The mother
will need help to put the baby to the breast for a day
or two.
- Exclusive Breastfeeding
Druing the first few months and as far as possible, till
the age of 4-6 months, "exclusive" breastfeeding shoudl
be practiced; young infants do nto require any additional
food or water or any other fluid such as tea, herbal water,
glucose water, fruit drinks, etc. Breastmilk alone is
adequate to meet the hydration requirements even under
extremely hot and dry summer conditions of the country.
- Diet of Lactating Mother
A lactating woman should be advised to eat an extra helping
of the family fod and regular consumption of green leafy
vegetables. There is no need to avoid any specific foods;
however, use of excessive caffeine, tobacco, and alcohol
etc. should be discouraged.
- Important Special Situations
- Low Birth Weight
Infants
Mother's milk is the best food for the low birth weight
babies. The borderline term and growth retarted low
birth weight babies can suckle fairly well at the
breast and should be given expressed breastmilk in
preference to formula feeds by appropriate techniques
such as clean cup and spoon, tubes, "paladai" etc.
The child should be put directly to the breast as
soon as possible.
- Common Illnesses
in the infant.
Breastmilk is the most easily digestible food for
an ill baby. Feeding
common infantile ailments including diarrhea and acute
respiratory infections. Breastfeeding must, therefore,
be ensured during such illnesses. The children may
suckle less vigorously or for a shorter time and should
receive the feeds at more frequent intervals. However,
breastfeeding adn for that matter, any type of feeding
should not be attempted in critically ill infants.
- Illness in Mother
Most common maternal illnesses do not require discontinuation
of breast feeding. Breastfeeding is recommended even
with mastitis, breast abscess and other infectious
illnesses including urinary tract infection, tuberculosis,
human immunodeficiency virus (AIDS), physically incapacitating
systemic illnesses may prevent or necessitate discontinuation
of breastfeeding. Psychosis is a contraindication
for breastfeeding on account of abnormal maternal
behavior. In such situations, whereve feasible, the
breasts should be emptied frequently to maintain lactation.
- Drug intake in
Mother
Drug therapy shoudl be avoided in lactating mothers
and when necessary, a safer alternative should be
prescribed. Drug intake should preferably be timed
during or immediately after breastfeeding. Majority
of the commonly used preparations are compatible with
safe breastfeeding. Only a few drugs necessitate discontinuation
fo breastfeeding like anti cancer and anti thyroid
therapy, radioactive preparations, ergot, gold salts,
lithium, etc.
- Breastfeeding Subtitutes
If a mother can not for some reason exclusively brastfeed
her young infant (below 4 to 6 months age), for example
a working mother, her expressed milk shoul be given
to the baby in preference to other animal or formula
milks.
Rarely, if it is unavoidable - at least partially
- to give non human milk in the first 4 to 6 months
of life, undiluted milk normally be utilized and commercial
infant milk foods should be strongly discouraged.
In infants, part of excessive fat in buffalo’s
milk should be removed by separating the cream from
milk after boiling and cooling to room temperature.
Young infants
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