Literature of any type (no water, no juice,

Literature Review:Definitions ofBreastfeeding:A mainstream amount studies did not discriminate between limitedand partially breastfed infants, or explain the difference between”breastfeeding” and “feeding of expressed breast milk.” The term”breastfeeding” is applied for studies in full-term infants and the term “humanmilk feeding” is applicable for studies in preterm infantsExclusive breastfeeding is defined as an infant’sconsumption of human milk with no supplementation of any type (no water, nojuice, no nonhuman milk, and no foods) except for vitamins, minerals, andmedications. Breastfeeding the baby can bring many welfares and helpcreate a bond with the baby.

Extensive research using improved epidemiologicmethods and modern laboratory techniques documents varied and convincingadvantages for infants, mothers, families, and society from breastfeeding anduse of human milk for infant feeding (Krameret al., 2001). These advantages include health, nutritional, immunologic,developmental, psychologic, social, economic, and environmental benefits. In1997, the American Academy of Pediatrics (AAP) published the policystatement Breastfeeding and the Use of Human Milk (American Academy of Pediatrics, 1997). Sincethen, significant advances in science and clinical medicine have occurred.

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Thisrevision cites substantial new research on the importance of breastfeeding andsets forth principles to guide pediatricians and other health careprofessionals in assisting women and children in the commencement andmaintenance of breastfeeding. The ways pediatricians can protect, promote, andsupport breastfeeding in their individual practices, hospitals, medicalschools, and communities are delineated, and the central role of thepediatrician in coordinating breastfeeding management and providing a medicalhome for the child is emphasized as stated by the American Academy ofPediatrics (2002).THE NEEDChild Health BenefitsHuman milk is species-specific, and all substitute feedingpreparations differ markedly from it, making human milk exceptionally superiorfor infant feeding (Hambreaus et al.

,1975) Exclusive breastfeeding is the reference or normative model againstwhich all alternative feeding methods must be measured with regard to growth,health, development, and all other short- and long-term outcomes. In addition,human milk-fed premature infants receive significant benefits with respect tohost protection and improved developmental outcomes compared with formula-fedpremature infants (Lucas et al.,1998). Fromstudies in preterm and term infants, the following outcomes have beendocumented.Infectious DiseasesResearch in developed and emergent countries of the world,including middle-class populations in developed countries, provides strongevidence that human milk feeding decreases the incidence and/or severity of awide range of infectious diseases (Heinig et al., 2001) including bacterial, (Hopkins etal., 1986) meningitis.

 bacteremia, diarrhea, respiratory tractinfection, (Howie et al., 1990), urinarytract infection. In addition, post neonatal infant mortality rates in theUnited States are reduced by 21% in breastfed infants (Rogan et al., 2004).

Other Health OutcomesSome studies suggest decreased rates of sudden infant deathsyndrome in the first year of life (McVea et al., 2000) and reduction inincidence of insulin-dependent (type 1) and non–insulin-dependent (type 2)diabetes mellitus, (Mosko et al.,1997) lymphoma, leukemia, and overweight and obesity, (Benner& Armstrong et al.

, 2002) hypercholesterolemia, andasthma in older children and adults who were breastfed, compared withindividuals who were not breastfed. Additional research in this area is defensible.NeurodevelopmentBreastfeeding has been associated with slightly enhancedperformance on tests of cognitive development (Horwood et al., 1998).

 Breastfeeding during a painfulprocedure such as a heel-stick for newborn screening provides analgesia toinfants.Maternal HealthBenefitsImportant health benefits of breastfeeding and lactation arealso described for mother (Labbok, 2001). The benefits include decreasedpostpartum bleeding and more rapid uterine involution attributable to increasedconcentrations of oxytocin, (Ratnamet al., 1994) decreased menstrual blood loss and increased childspacing attributable to lactational amenorrhea, earlier return toprepregnancy weight, (Kennedy et al.,1996), decreased risk of breast cancer, (Newcomb & Tim at al.

, 2003) decreasedrisk of ovarian cancer, and possibly decreased risk of hip fractures andosteoporosis in the postmenopausal period (Jernstormet al., 2004).Community BenefitsIn addition to specific health advantages for infants andmothers, economic, family, and environmental benefits have been described.

decreased costs for public health programs, decreased parental employee malingeringand associated loss of family income; more time for attention to siblings andother family matters as a result of reduced infant illness; decreasedenvironmental burden for removal of formula cans and bottles; and decreasedenergy demands for production and transport of artificial feeding products (Cohen & Levine at al., 1992) Thesesavings for the country and for families would be offset to some unknown extentby increased costs for physician and lactation discussions, increasedoffice-visit time, and cost of breast pumps and other equipment, all of whichshould be covered by insurance payments to providers and families.CONTRAINDICATIONS TO BREASTFEEDINGAlthough breastfeeding is optimal for infants, there are afew conditions under which breastfeeding may not be in the best interest of theinfant (Chen et al., 2000); mothers who have active untreatedtuberculosis disease or are human T-cell lymphotropic virus type I–orII–positive (Ando and Nakano et al.,1989); mothers who are receiving diagnostic or therapeutic radioactive isotopesor have had exposure to radioactive materials (for as long as there isradioactivity in the milk) (Robinson et al., 1994); mothers who are receivingantimetabolites or chemotherapeutic agents or a small number of other medicationsuntil they clear the milk (Bakheer & Egan et al.

, 1998); mothers who are using drugs of abuse (“street drugs”); andmothers who have herpes simplex grazes on a breast (infant may feed from otherbreast if clear of lesions). Appropriate information about infection-controlmeasures should be provided to mothers with infectious diseases.Mothers who are infected with human immunodeficiency virus(HIV) have been advised not to breastfeed their infants (Read et al.

, 2004). In developing areas of theworld with populations at increased risk of other infectious diseases andnutritional deficiencies resulting in increased infant death rates, themortality risks associated with false feeding may outweigh the possible risksof acquiring HIV infection (Kourtis et al., 2003). One study in Africadetailed in 2 reports (Lawrence etal., 1999) found that exclusive breastfeeding for the first 3 to 6 monthsafter birth by HIV-infected mothers did not increase the risk of HIVtransmission to the infant, whereas infants who received mixed feedings(breastfeeding with other foods or milks) had a higher rate of HIV infectioncompared with infants who were exclusively formula-fed. CONDITIONS THAT ARENOT CONTRAINDICATIONS TO BREASTFEEDINGCertain conditions have been shown to be compatible withbreastfeeding.

Breastfeeding is not contraindicated for infants born to motherswho are hepatitis B surface antigen–positive, (Berlin et al., 2002) mothers who are infected withhepatitis C virus (persons with hepatitis C virus antibody or hepatitis Cvirus-RNA–positive blood), (American Academy of Pediatrics, 2003) motherswho are febrile (unless cause is a contraindication outlined in the previoussection), (Coutsoudis et al., 2003). Tobacco smoking by mothers is not a contraindication tobreastfeeding, but health care professionals should advise all tobacco-usingmothers to avoid smoking within the home and to make every effort to weanthemselves from tobacco as rapidly as possible (Spooner and Kuhn et al.

, 2003).Breastfeeding mothers should avoid the use of alcoholicbeverages, because alcohol is concentrated in breast milk and its use caninhibit milk production. An occasional celebratory single, small alcoholicdrink is acceptable, but breastfeeding should be avoided for 2 hours after thedrink (Andersen et al.

, 1982).For the great majority of newborns with jaundice andhyperbilirubinemia, breastfeeding can and should be continued withoutinterruption. In rare instances of severe hyperbilirubinemia, breastfeeding mayneed to be interrupted temporarily for a brief period (American Academy ofPediatrics, 2004).THE CHALLENGEMany of the mothers counted as breastfeeding were accompanyingtheir infants with formula during the first 6 months of the infant’slife. Although breastfeeding instigation rates have increased steadilysince 1990, exclusive breastfeeding initiation rates have shown little or noincrease over that same period of time. Similarly, 6 months after birth, theproportion of infants who are exclusively breastfed has increased at a muchslower rate than that of infants who receive mixed feedings Exclusivebreastfeeding has been shown to provide better-quality protection against manydiseases and to increase the probability of continued breastfeeding for atleast the first year of life.

Hindrances to commencement and extension of breastfeedinginclude inadequate prenatal education about breastfeeding, troublesome hospitalpolicies and practices, unsuitable disruption of breastfeeding,early hospital discharge in some populations, lack of timely routinefollow-up care and postnatal home health visits, maternal employment, (especiallyin the absence of workplace facilities and support for breastfeeding), lack offamily and broad societal support, media depiction of bottle feeding asnormative, profitable promotion of infant formula through distributionof hospital discharge packs, vouchers for free or discounted formula, and sometelevision and general magazine promotion, misinformation; and lack of guidanceand encouragement from health care professionals.BREASTFEEDING FORHEALTHY TERM INFANTSPediatricians and other health care professionals shouldrecommend human milk for all infants in whom breastfeeding is not specificallycontraindicated and provide parents with complete, current information on thebenefits and techniques of breastfeeding to ensure that their feeding decisionis a fully informed one (Gartner et al., 2001).When direct breastfeeding is not possible, expressed humanmilk should be provided. If a known contraindication to breastfeeding isidentified, consider whether the contraindication may be provisional, and ifso, advise impelling to maintain milk production.

Peri partum policies and practices that optimizebreastfeeding initiation and maintenance should be encouraged. Education ofboth parents before and after delivery of the infant is an essential componentof successful breastfeeding. Support and encouragement by the father cangreatly assist the mother during the initiation process and during subsequentperiods when problems arise.

Consistent with appropriate care for the mother,minimize or modify the course of maternal medications that have the potentialfor altering the infant’s alertness and feeding behavior (Widstrom et al.,1993). Healthy infants should be placed and remain in directskin-to-skin contact with their mothers immediately after delivery until thefirst feeding is accomplished.

The alert, healthy newborn infant iscapable of latching on to a breast without specific assistance within the firsthour after birth (Righard et al., 1990)Supplements (water, glucose water, formula, and other fluids) should not begiven to breastfeeding newborn infants unless ordered by a physician when amedical indication exists. (VenDen Bosch et al.

, 1990).During the early weeks of breastfeeding, mothers should beencouraged to have 8 to 12 feedings at the breast every 24 hours, offering thebreast whenever the infant shows early signs of hunger such as increasedalertness, physical activity, mouthing, or rooting (Gunther et al., 1995).Crying is a late indicator of hunger (Klaus et al., 1987). Appropriateinitiation of breastfeeding is facilitated by continuous rooming-in throughoutthe day and night. At each feed the first breast offered are alternated so thatboth breasts receive equal stimulation and draining. After breastfeeding iswell established, the frequency of feeding may decline to approximately 8 timesper 24 hours, but the infant may increase the frequency again with growthspurts or when an increase in milk volume is desired.

Formal evaluation of breastfeeding, including observation ofposition, latch, and milk transfer, should be undertaken by trained caregiversat least twice daily and fully documented in the record during each day in thehospital after birth.Pediatricians and parents should be aware that exclusivebreastfeeding is sufficient to support optimal growth and development forapproximately the first 6 months of life‡ and provides continuing protectionagainst diarrhea and respiratory tract infection. Breastfeeding should becontinued for at least the first year of life and beyond for as long as mutuallydesired by mother and child (Kramer et al.

, 2002).Complementary foods rich in iron should be introducedgradually beginning around 6 months of age (Butteet al., 2004). Preterm and low birth weight infants and infants withhematologic disorders or infants who had inadequate iron stores at birthgenerally require iron supplementation before 6 months of age. Iron may beadministered while continuing exclusive breastfeeding.Introduction of complementary feedings before 6 months ofage generally does not increase total caloric intake or rate of growth and onlysubstitutes foods that lack the protective components of human milk. During thefirst 6 months of age, even in hot climates, water and juice are unnecessaryfor breastfed infants and may introduce contaminants or allergens (Ashraf et al.

,1993). Increased duration of breastfeeding confers significant health anddevelopmental benefits for the child and the mother, especially in delayingreturn of fertility (thereby promoting optimal intervals between births) (Huffmanet al., 1987). There is no upper limit to the duration of breastfeeding and noevidence of psychologic or developmental harm from breastfeeding into the thirdyear of life or longer (Detwyler et al., 1995).

ADDITIONALRECOMMENDATIONS FOR HIGH-RISK INFANTSHospitals and physicians should recommend humanmilk for premature and other high-risk infants either by direct breastfeedingand/or using the mother’s own articulated milk. Maternal support andeducation on breastfeeding and milk countenance should be provided from theearliest possible time. Mother-infant skin-to-skin contact and directbreastfeeding should be encouraged as early as possible. Fortification ofexpressed human milk is indicated for many very low birth weight infants. Massedhuman milk may be a suitable feeding alternative for infants whose mothers areunable or unwilling to provide their own milk. Human milk banks in NorthAmerica adhere to national guidelines for quality control of screening andtesting of donors and pasteurize all milk before distribution.

(Hughes et al., 1990) Fresh humanmilk from unscreened donors is not recommended because of the risk of transmissionof infectious agents (Kaplan et al., 1998).


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