Abstract Ref Number = APCP145
Feeding fundas-From ½ hour to ½ yearand beyond
DYPatil Medical College, Pune, India
National President, Indian Academy of Pediatrics,
Breastfeeding is a cornerstone of children’s survival, nutrition and early development. Breastfeeding not only provides children with the best start in life, it also benefits maternal health, protects against non-communicable diseases and contributes to environmental sustainability.Early initiationand Exclusive breastfeeding till six months are the two important aspects of infant feeding.
We need to improve on our knowledge, attitudes and skills in certain areas
• The concept‘Protect, Promote, and Support Breastfeeding’ is not known to many . We need to be aware of its enormous importance- not only as a public health measure, but also in the day-to-day practice.
• Some ‘obsessed’tricians (obsessed with infant milk formula ),and also some pediatricians ,soon after the newborn examination, prescribe infant milk formulato all the newborns delivered in the nursing homes believing that the baby always needs some external milk for the first few days. Whenever the mother says that she has less milk, the formula is prescribed at the drop of a hat.
• Most pediatricians do not check the percentage of weight loss after birth and thus miss out on timely intervention if lactation is not getting established. They know that some weight is lost after birth initially but do not give importance to the amount of weight loss. Many do not know the tests for adequacy of the breastfeeding, especially in the first 2 weeks when lactation is getting established. Finding excessive weight loss in first few days can alert the pediatrician to failure of establishment of lactation and prompt proper action can be taken. Many pediatricians do not even check the adequacy of lactation later with wetness test and weight gain test.
• The first time mother, mother with breastfeeding problems in previous pregnancy, mother with caesarean delivery, baby with birth weight <2.5 kg, any mother reporting pain in breast and any baby who was sick and separated from mother need to be assessed in detail. These are the situations where so called ‘lactation failure’ can occur. Many of us make no efforts to help mother increase her milk supply where the supply is really low, probably due to lack of knowledge about science of lactation . The only option resorted to is formula. One should speak out and tell the mother that frequent sucking is the only way of getting early and enough milk, also explain that areolar sucking and not the nipple sucking is important and show proper positioning. I am sure many mothers even after a long period of mixed feeding can turn to exclusive breastfeeding or at least predominant breastfeeding with proper counseling and support involving the other family members.
• Most of us do not know handling of breastfeeding problems. Every pediatrician and obstetrician should know the management of breast engorgement, breast abscess, cracked nipples, etc.
• Many pediatricians have a misconception about the risk of hypoglycemia with exclusive breastfeeding. They believe that hypoglycemia will always occur and hence prescribe sugar water initially.
• The risk of dehydration and hyperbilirubinemia in summer is mainly due to the environmental heat and not due to the inadequacy of breastmilk. The solution is not giving water or formula to the baby either to prevent or treat these conditions; the solution is to maintain the appropriate temperature in the baby’s surroundings along with more frequent breastfeeds.
• Baby Friendly Hospitals Initiative (BFHI) and Ten Steps to Successful Breastfeeding are not known to many pediatricians.It is necessary that a pediatrician develops a good rapport with the obstetric colleagues and helps them make their maternity homes BFHI certified and see that all babies start their life withBREAST sutras which include Breast crawl, Refraining from prelacteal feeds like sugar water and formula, Exclusive breastfeeding ,proper Attachment, Support to the mother and Training of paramedics.
My ‘position’ as former President of IAP and ‘attachment’ with promotion of breastfeeding will be of some worth only if every pediatrician remembers PRAMOD and become Proactive, are Ready to give time, get Academically perfect in the science of breastfeeding, Motivate the mothers and paramedics, convince the Obstetricians and Discard bottles and tins.