Infant and Young Child feeding

Child Nutrition - Must Know Facts

• Good nutrition before birth, through the mother’s good health, and in the first years of life improves the child’s growth and the child’s ability to learn. Also, good nutrition helps prevent illness.
• Poorly nourished children do not grow well. They are shorter than other children of the same age. They are less interested in eating food and are often quite fussy. They are less active when they play and have less interest in exploring and learning.
• Also, poorly nourished children are often sick. And illness is a special challenge for a body that is already weak from poor nutrition.
• Nearly half of the children who die from common childhood illness, diarrhoea, pneumonia, malaria, measles, and other infections—are poorly nourished. Helping young children get better nutrition helps prevent early deaths.

Early initiation of breastfeeding

Why should breastfeeding be initiated early after the birth of the baby ?

Breastfeeding should be started as soon as the baby and the mother are ready usually within the first 60 minutes after the birth and not later than one hour. If the baby cannot be put to breast after early, even skin to skin contact with the mother helps the milk to flow. The baby is alert around this time. The family can see that the baby is ready for breastfeeding when he/she opens the mouth, turns the head as if searching for the nipple or sucks on fingers or hands. Starting breastfeeding early is one of the best actions that the mother can do to help her baby be healthy it many advantages for the baby and the mother. The baby gets all the benefits of the first milk which is like the baby’s first vaccination and protects the baby from illness. It also helps to act as a purgative, clear meconium, and prevent jaundice. It is very rich in vitamin A which is important for the eyes.

Early suckling helps make more milk, encourages the flow of breastmilk, prevents early problems with breastfeeding, helps keep the baby warm, promotes the bonding between the mother and the baby. It has various advantages for the mother also. It is useful in expulsion of the placenta, reduction of bleeding in the mother, prevents breast engorgement and makes mothers feel comfortable.

The importance of breastfeeding the young infant and child

Breastfeeding is important for the healthy growth of the young child. Breastfeeding also strengthens the relationship between mother and child. A close, loving relationship is a foundation for the mother’s important caring role from the child’s birth and as the child grows.

Through breastfeeding the mother and her baby learn early how to communicate with each other—to be sensitive to each other’s signals and respond appropriately. Their satisfaction helps sustain the care the child will continue to need for healthy survival and social development.

Exclusive Breastfeeding

1. Feeding only breastmilk is best for young infants and children up to age 6 months. Exclusive breastfeeding means that the child takes no additional food, water, or other fluids, starting at birth. (The child can take medicine and vitamins, if needed on medical advice).
2. Exclusive breastfeeding gives an infant the best chance to grow and stay healthy.
• It promotes production of more milk. Giving other food or fluids reduces the amount of breastmilk the child takes and, as a result, the amount of breastmilk the mother produces too is reduced.
• It decreases the transmission of germs from the environment. Water, feeding bottles, and utensils can pass germs to the young infant, even when they appear “clean”. The infant can become sick from the germs.
• It ensures that the milk the child gets is nutritious. Breastmilk contains all the nutrients that a baby needs during the first 6 months of life. Other foods or fluids may be too diluted or thin and can be contaminated.
• It provides enough iron. Iron contributes to the development of the brain, and helps the child focus attention. Iron from breastmilk is absorbed better.
• Young infants often have difficulty digesting animal milk.
• Animal milk may cause diarrhoea, rashes, or other allergies. Diarrhoea may continue and become persistent, leading to undernutrition.

The support of the community health worker and the family helps the mother succeed in her goal to exclusively breastfeed.

3. Breastfeed as often as the baby wants-on demand
   
   • A mother is encouraged to put her newborn to her breast as soon as possible after birth, but not later than 1 hour. It is not necessary to wait until the baby has been cleaned or the milk begins to come. Suckling helps the breastmilk to come.
   • The baby’s stomach is small. Therefore the baby should be fed frequently on demand-at least 8 - 12 times in 24 hours, day and night - in order to be adequately nourished.
   • Breastfeeding helps the mother and baby to form a close loving relationship which makes mothers feel deeply satisfied emotionally Feeding the baby more than 8 times in the day and night provides a unique opportunity for the mother and the baby to be in close touch, enjoy each other’s company, stimulate each other and respond to each other’s needs. Low birth weight babies can learn to suckle if the mother strokes their sides of the lips and the upper part of the chin before feeding them several times in the day. Feeding and stimulation together will help the development of the brain of the baby and promote bonding between the mother and the baby. It also helps the mother to overcome her depression during the first few weeks after delivery.
   • A mother learns to recognize the baby’s way of communicating hunger. The baby might rub the mouth with a fist, start to fuss, or open the mouth wide towards the breast. These are indications that the baby is ready for breastfeeding. The mother does not need to wait until the baby cries before she recognizes hunger and gives the baby her breast. The mother should not wait for the baby to cry before feeding it. Crying is a late sign of hunger.
   • If the mother is aware of the signals of hunger, she is able to interpret them correctly, this is sensitivity. If the mother understands the signal in time and feeds the baby it indicates responsiveness.

Positioning and attachment for breastfeeding

Positioning and attachment are important in the success of breastfeeding. These are important for mothers to learn and practice.

• The mother should position the baby well so that it is easier for the baby to attach to the breast and suckle effectively. The mother should first sit comfortably with her back supported. Resting her arm on a pillow may help her hold the baby more easily and longer without discomfort.
• Hold baby close to her.
• Face the baby to the breast.
• Hold the baby’s body in a straight line with the head.
• Support the baby’s whole body.
• Make sure that the baby is well-attached to the breast.
• There are other positions in which the mothers can breastfeed their babies comfortably. The mother can feed the baby in lying down position or in underarm position. Mothers who have had a C section may find the position to be more comfortable.

Make sure that the baby is well-attached to the breast

• For the baby to suckle well, make sure that the baby is attached well to the breast. A well- attached baby suckles with the mouth wide open (M), chin close and touching the breast (C), the lower lip turned outward (L) and with more areola seen above the baby’s mouth than below (A). The four components of good attachment can be remembered by thinking about the acronym CALM.
• When the baby suckles, you may hear a sound indicating that the baby is suckling effectively. The baby may pause during sucking, because the baby is swallowing. The mother should not get worried.

Expression of breastmilk

There are many situations early in life when breastmilk may have to be expressed. This has to be done to relieve the engorgement (fullness and pain) of the breasts, or if the mother has inverted nipples, or while feeding a baby who has difficulty in suckling e.g. a low birth weight or a premature baby or a sick baby. Expression of breastmilk is also needed if the mother is sick or in situations when mother has to go out for work and cannot take the baby along with her.

The key steps in expressing the breastmilk are summarized below.

• Mother should express the breastmilk herself
• She should wash her hands well before expressing the milk and sit comfortably and hold a clean katori near her breast
• She should put her thumb above the nipple and areola on the breast and her first finger below the nipple and areola. After this she should support her breast with other fingers.
• The mother should then press the thumb and first finger towards the chest wall. She should press her breast behind the nipple and areola between her finger and thumb. Then she should press and release alternately. This should not hurt.
• The milk may take some time to flow so do not be alarmed. After pressing several times the milk will begin to flow. The milk may come out in streams. Avoid squeezing the nipple since this may hurt.
• Express one breast for about five minutes and wait for the milk flow to slow down. Then express the other side and then repeat both. It takes about 20-30 minutes to express the breastmilk especially during the first few days since only little milk may be produced.

Feeding a young infant too weak to attach well

• Most newborns and young infants are strong enough to begin suckling right away. However, a baby may be low weight or for other reasons too weak to take enough milk. It may be necessary to express milk from the breast, and give it to the baby in small sips with a spoon or a small katori.
• Discourage the use of a feeding bottle. The use of the nipple on the feeding bottle will interfere with the newborn’s suckling on the breast. This makes it more difficult for the newborn to breastfeed effectively. Also, a bottle and nipple are more difficult to clean well than a katori.

Continued breastfeeding

Continue to breastfeed the child older than 6 months - Children older than 6 months still benefit a lot from breastfeeding. From age 6 upto 12 months, breastmilk provides half of the child’s nutritional needs. From 12 months upto 2 years, it continues to provide one-third of a child’s needs. Breastmilk also continues to protect the child from many illnesses, and helps the child grow. Therefore, a mother should continue to breastfeed as often as the child wants.

Feed the child (age 6 months to two years)

• Introduce complementary foods at age 6 months - Complementary foods are foods that are given to the young child in addition to breastmilk, since the breastmilk is not sufficient to meet the needs of the child. Without additional food to complement the breastmilk, children can lose weight and falter during this critical period. The amount and the variety of foods that children need will increase as the child grows.
• Good complementary foods are nutrient- rich, energy-rich, and locally available. Foods should be safe and hygienically prepared. They should be prepared in a consistency that is nutritionally rich and acceptable for the young child to eat.
• A nutrition-rich diet requires a variety of foods. Iron, vitamin A and iodine are very important for development of the brain as well as for child’s growth. Zinc helps to prevent illness.
• To be an energy-rich food, the food should also be prepared thick - so it stays on a spoon. Thin soups and cereals fill the stomach but do not provide enough energy for a growing child.

Sources of important micronutrients

1. Best sources for iron: animal meat and organ foods (for example, liver), egg and fish. Among vegetarian foods, soya beans and other pulses, drumstick, coriander, fenugreek curry leaves, mint, beet root and turnip leaves, dry dates, raisins, dry mango powder, water melon and whole wheat flour.
2. Zinc helps to prevent illness. Best sources for zinc: same as iron.
3. Vitamin A contributes to healthy eyes and brain development, and prevents illness. Best sources are animal foods, fish, liver, egg, milk and milk products. In a vegetarian diet the foods rich in vitamin A are sweet potatoes, carrot, yellow pumpkin, spinach, fenugreek, sarson (mustard), parwal, papaya, musk melon, orange, sweet lime and mango
4. Iodine is available in iodized salt. It is very important for brain development.

The following chart summarizes the changes in the feeding advice as the child grows.

Snacks are ready to eat foods (banana, and other fruits) or especially prepared for the child (like panjeeri, laddoo, halwa, upma, idli, poha etc). Family foods can also be given as snacks in small quantities. These are given in between meals. Snacks are not a replacement of meals.

Complementary foods as meals are those that are especially prepared for the child. These are soft, easy to digest in a semi solid form and nutritious. These can also be family foods that are made suitable for the consumption by the young child. Examples include dal with rice or crushed bread (chapati), boiled vegetables with butter or ghee as thick soup, or mixed with crushed bread (chapati). There should be no spices in the child’s food and additional oil is put for making it rich, tasty and easy to swallow.

Feed the child responsively

Breastfeeding on “demand” requires the mother to be sensitive to the signs that her child is hungry and to be responsive. The mother should recognize the signs of hunger for semi solid foods also and respond as soon as possible. As the child grows, these basic caregiving skills - sensitivity and responsiveness - continue to be important to meet the child’s nutritional needs.

Source : Sensitisation Module on Infant and Young Child feeding

Related resources

1. Counselling guide on Infant and Young Child Feeding
2. Information tool for ASHA workers on Infant and Young Child Feeding