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breastfeed

 
Dictionary: breast·feed or breast-feed (brĕst'fēd') pronunciation
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v., -fed (-fĕd'), -feed·ing, -feeds.

v.tr.
To feed (a baby) mother's milk from the breast; suckle.

v.intr.
To breastfeed a baby.


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Food and Fitness: breast-feeding
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Breast milk is the perfect food for a newborn baby. It contains a balanced mixture of carbohydrates, fats, and proteins, with adequate amounts of vitamins (except vitamin D) and minerals. During the first two weeks, breast milk is called colostrum or early milk. It contains substances (e.g. immunoglobulins, lactoferrin, and lysozyme) that provide some immunity from infection. Breast-feeding lowers the incidence of food allergies in infants, especially those from families with a history of hypersensitivity.

A study of 926 babies born before the normal 40 week term of pregnancy, found that those fed on breast milk had significantly higher IQs by the time they were 7 years old, than those given formula milk. It was suggested that the effect was due to breast milk containing long chain polyunsaturates, special fatty acids similar to those found in oily fish. These are believed to help the nervous system to develop.

During lactation, the dietary demands of the mother are greater than during pregnancy. A breast-feeding mother has to produce milk continually to satisfy the incessant demands of her child. She has to consume sufficient nutrients for herself and her infant. She can obtain most of these nutrients, especially protein, calcium, magnesium, and vitamin B2, from cow's milk. (Newborn babies cannot cope with cow's milk because it contains more protein than the infant can deal with and a high mineral content which may damage their kidneys.) Other calcium-rich foods include cheese, yoghurt, soya milk, and dark green vegetables. At least three servings of such foods should be eaten each day.

If the mother's intake of vitamins and minerals is inadequate, the quantity of milk is more likely to be affected than its quality. The baby's supply of vitamins and minerals is usually maintained at the expense of maternal body stores. The American Medical Association is one of several reputable organizations to suggest that multivitamin-mineral supplementation may be beneficial to lactating women.

A nursing mother's milk contains large amounts of water, so she should drink plenty of fluids (at least eight glasses a day) to prevent the supply of milk from drying up.

Anything the mother consumes may affect the quality of her milk. If she smokes tobacco, drinks alcohol, or takes other drugs, the toxins from these substances may seep into her milk and affect the infant.

Lactating mothers often feel overweight, but should not go on a severe weight-loss diet. The mothers need to retain some fat in the breasts and other fat stores for milk production. However, a slow and steady weight loss, no more than 1 kg (2.2 lb) per week, is possible through a sensible selection of low-calorie, nutritious foods. Most fat is lost, anyway, once lactation stops and, in the long term, mothers who breast-feed tend to retain less fat than those who do not.

Psychoanalysis: Breastfeeding
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Suckling is the action whereby milk is fed to the infant until it is weaned. By extension, the term refers to breastfeeding as well as bottle-feeding. Before an emphasis was placed on the importance of the object and the infant's environment, psychoanalysts spoke little of maternal suckling. However, Sigmund Freud, in a text that needs to be viewed in historical context, titled "A Case of Successful Treatment by Hypnotism," evokes the case of a young woman, "occasionally hysterical . . . who is willing to feed her infant but behaves as if she doesn't want to" (1892-93a). The dimension of the unconscious conflict is not taken into account here and Freud clings to the idea of will and counter-will. An outline of maternal psychopathology is given, and here the difficulties of breastfeeding are treated by hypnosis.

Suckling is not a psychoanalytic concept. In speaking of suckling we cannot forget the physical link associated with the reality of the nutritive relation. The image of the infant at the mother's breast has considerable metaphoric and symbolic value; it is an image that makes us nostalgic for a sense of original fulfillment and can be compared with that other, "final," image of death, as characterized by the iconography of the old man at the breast. The container, the breast, and its content, milk, are both associated with projected fantasies. The milky substance, a liquid that contrasts with the solidity of the breast, is a vehicle of fantasies of fusion and vampirism. Once the infant's teeth begin to grow, the fantasies are those of oral sadism and cannibalism. There is an analogy to be made between the breast and the penis, between milk and sperm, one of which nourishes and one of which fecundates, and at the same time an incompatibility because sperm is, in fantasy at least, supposed to spoil milk; thus there is a separation between the sexual and the nutritive.

A dichotomy has always existed between the breast as a nourishing object and the breast as an erotic object, a separation that helps avoid the confrontation between an incestuous mother and the importance of maternal libidinal and erotic investment. However, in The Interpretation of Dreams (1900a), commenting on the "dream of the Fates (Knödel), Freud wrote that "at the woman's breast love and hunger meet." For the breast satisfies both the alimentary and the sexual impulses: "To begin with, sexual activity attaches itself to functions serving the purpose of self-preservation and does not become independent of them until later. No one who has seen a baby sinking back satiated from the breast and falling asleep with flushed cheeks and a blissful smile can escape the reflection that this picture persists as a prototype of the expression of sexual satisfaction in later life" (1905d). The nipple is a sexual object throughout Freudian metapsychology. The transition from sucking the nipple to sucking is a key moment in the organization of the earliest feelings of autoeroticism and investment of the mouth as an erogenous zone. Freud does not mention (Laplanche, 1997) the erogenous erotic component for the mother during breast-feeding. For the infant the breast assumes (secondarily) its forbidden erotic value with the organization of the oedipal conflict; initially the infant simply "is the breast" (Freud, 1941f [1938]), during a period of primary identification with the breast and primal fusion.

It has become obvious that the object plays a key role in enabling the polarization of the libido into certain zones. This follows their unification when the infant is breastfeeding and the libido experiences a sense of satisfaction, at a time when the mouth that sucks and the nipple that nourishes are inseparable and indistinguishable. The mother "(moreover) makes a gift to the infant (while she is lavishing her attention on him) of feelings arising from her own sexual life . . . and clearly grasps these as a substitute for a separate sexual object" (1905d). Freud returned to this position and developed it in his Outline of Psychoanalysis: "She is not content to nourish, she cares for the infant and thus awakens in him many other physical sensations, agreeable and disagreeable. Thanks to the care she lavishes, she becomes his first seductress. Through these two relations, the mother acquires unique importance, incomparable, unalterable, and permanent, and becomes for both sexes the object of the first and most powerful of his loves, the prototype of all later amorous relations" (1940a [1938]).

The role of the object and precocious maternal seduction as it occurs through breastfeeding are questioned by contemporary analysts. Jean Laplanche (1987) has developed the idea that sexuality is implanted in the infant through the initial seduction of the adult, and emphasizes the unconscious sexuality of the seducer. From this follows the possibility of a significant reassessment of the role of the impulses, the role of the object, and anaclisis; he also raises the question of the primal. For Paul Denis the question of mastery is present at the heart of the initial experiences of feeding, but the encounter between the mouth and the nipple, to the extent that it combines kinesthetic and sensory feelings, instinctual excitation and pleasure/unpleasure, is an essential period during which the activity of the initial representation takes place (the "pictogram" of Piera Aulagnier, 1975). For authors such as Esther Bick, the emphasis is on the presence-absence of the breast during this primitive stage of undifferentiated autosensuality characterized by the encounter between mouth and nipple. The role of the object remains essential for enabling the consensual union and unification of the libido. The mother's container function is experienced as a "skin": "The optimal object is the nipple in the mouth, together with the mother's touch (holding), speech, and familiar odor"(1968).

With respect to bottle or breastfeeding, Freud responds only in terms of privation. In all cases there remains a feeling of "having sucked too little and for too short a time," the nostalgia for the breast being stronger for the child who has been bottle-fed (1940a [1938]). Melanie Klein (1952), writing about breast-and bottle-feeding, returns to the question of the primacy of the object and instinct, the importance of the exterior object and the reality of the breast. For her the breast is the object of intense fantasized projections because it is a primordial object. The cannibalistic oral impulses directed toward the mother's breast are especially intense. As for the mother, the fact of feeding her baby has a restorative effect because it terminates the sadistic fantasies with respect to her own mother: "The nourishing and beneficial milk she dispenses signifies for the unconscious that her sadistic fantasies have not been realized and that their objects have rediscovered their integrity"(1932).

For Donald Winnicott breastfeeding is expanded to the baby's environment in the broad sense and to the richness of the experience the mother offers. The quality of maternal holding and handling is essential, for these are both a function of the mother's internal conflicts and of her own infantile experiences. The foundations of psychic health depend on this "facilitating environment." The experience of the survival of the object in the face of the baby's attacks seems to her essential and in the end helps her advance the idea of difference "between the survival of a part of the mother's body and the survival of a bottle" (1987). Although he is cautious when discussing mothers and does not dismiss the unconscious maternal implications, he emphasizes the importance of the carnal reality of the experience of the breast; in this body-to-body relation, the exchange of glances and the sensual experience are essential to communication.

Breastfeeding is a situation that so profoundly involves the mother's body and psychic life that it is subjected to the unconscious conflicts that affect the mother and to the fantasies awakened through the encounter between a specific mother and a specific infant. Suckling extends the period of pregnancy and birth and is inseparably a part of the woman's sexual life and her life history. Primitive psychic activity is associated with these very first contacts that are always difficult to conceptualize. Psychoanalysts who care for infants are conscious of this in their clinical activity and research.

The invention of the bottle (1820), followed by the introduction of sterilization (1892-1898), have profoundly altered breastfeeding. Artificial milk eliminates the need for direct recourse to another woman, in the position of wet-nurse, and the baby's survival (in reality) no longer depends on the product of the mother's body. The transition from mother's milk to artificial milk, while it abandons its natural origins, cannot be assimilated to the transition from raw food to cooked food discussed by Lévi-Strauss. But how can social and cultural ideology be made to mesh with unconscious maternal choices?

Bibliography

Bick, Esther. (1968). The experience of the skin in early object relations. International Journal of Psycho-Analysis, 49, 558-566.

Castoriadis-Aulagnier, Piera. (1975). La Violence de l'inter-prétation. Du pictogrammeà l'énoncé. Paris: Presses Universitaires de France, "Le Fil rouge."

Delegay-Siksou, Joyceline. (1986). Allaiter: au sein ou au biberon? Nourrir un enfant. Lieux enfance, 6-7, 35-57.

Denis, Paul. (1997). Emprise et satisfaction, les deux formants de la pulsion. Paris: Presses Universitaires de France.

Freud, Sigmund. (1892-93a). A case of successful treatment by hypnotism SE, 1: 115-128.

——. (1900a) The interpretation of dreams. Part I., SE,4: 1-338; The interpretation of dreams. Part II., SE, 5: 339-625.

——. (1905d). Three essays on the theory of sexuality. SE, 7: 123-243.

——. (1940a [1938]). An outline of psycho-analysis. SE, 23: 139-207.

——. (1941f [1938]). Findings, ideas, problems. SE, 23: 299-300.

Klein, Melanie. (1952). En observant le comportement des nourrissons. In Joan Riviere (Ed.), Developments in psychoanalysis. London: Hogarth Press ——. (1952). Quelques conclusions théoriques concernant la vie émotionnelle des bébés. In Joan Riviere (Ed.), Developments in psycho-analysis. London: Hogarth Press.

Laplanche, Jean. (1987). Nouveaux Fondements pour la psychanalyse. Paris: Presses Universitaires de France.

——. (1997). Le prégénital freudienà la trappe: après l'analyse. Revue française de psychanalyse, 61, 4: 1357-1369.

Winnicott, Donald W. (1987). Babies and their mothers. (Clare Winnicott, Ray Shepherd, and Madeleine Davis, Eds.). Reading, MA: Addison-Wesley.

Further Reading

Sarlin, Charles N. (1981). The role of breast feeding in psychosexual development and the achievement of the genital phase. Journal of the American Psychoanalytic Association, 29, 631-642.

—JOYCELINE SIKSOU

Wikipedia: Breastfeeding
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International Breastfeeding Symbol
An infant breastfeeding
Suckling and nursing are synonyms. For other uses, see Nursing (disambiguation) and Suckling (disambiguation)

Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts (i.e., via lactation) rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Most mothers can breastfeed for six months or more, without the addition of infant formula or solid food.

Human breast milk is the healthiest form of milk for human babies.[1] There are few exceptions, such as when the mother is taking certain drugs or is infected with tuberculosis or HIV. Breastfeeding promotes health, helps to prevent disease and reduces health care and feeding costs.[2] In both developing and developed countries, artificial feeding is associated with more deaths from diarrhea in infants.[3] Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas.[4][5][6]

Emphasizing the value of breastfeeding for both mothers and children, the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) both recommend exclusive breastfeeding for the first six months of life and then supplemented breastfeeding for at least one year and up to two years or more.[7][8] While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.[5]

The acceptability of breastfeeding in public varies by culture and country. In Western culture, though most approve of breastfeeding, some mothers may be reluctant to do so out of fear of public opinion.

Contents

Breast milk

Main article: Breast milk
Himba woman and child.

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development.[9] Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving birth.[10] The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child. The quality of a mother's breast milk may be compromised by stress, bad food habits, chronic illnesses, smoking, and drinking.[11]

Benefits for the infant

A woman with her child in Kabala, Sierra Leone in the 1960's.

Scientific research, such as the studies summarized in a 2007 review for the U.S. Agency for Healthcare Research and Quality (AHRQ)[12] and a 2007 review for the WHO[13], has found many benefits to breastfeeding for the infant. These include:

Less necrotizing enterocolitis in premature infants

Necrotizing enterocolitis (NEC) is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926 preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was 26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, compared with exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.[14] A 2007 meta-analysis of four randomized controlled trials found "a marginally statistically significant association" between breastfeeding and a reduction in the risk of NEC.[12]

Greater immune health

During breastfeeding antibodies pass to the baby[15]. Breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)[16][17] and immunoglobulin A protecting against microorganisms.[18]

Fewer infections

Among the studies showing that breastfed infants have a lower risk of infection than non-breastfed infants are:

  • In a 1993 University of Texas Medical Branch study, a longer period of breastfeeding was associated with a shorter duration of some middle ear infections (otitis media with effusion) in the first two years of life.[19]
  • A 1995 study of 87 infants found that breastfed babies had half the incidence of diarrheal illness, 19% fewer cases of any otitis media infection, and 80% fewer prolonged cases of otitis media than formula fed babies in the first twelve months of life.[20]
  • Breastfeeding appeared to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital in a 2002 study of 39 infants.[21]
  • A 2004 case-control study found that breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months of age, with the protection strongest immediately after birth.[22]
  • The 2007 review for AHRQ found that breastfeeding reduced the risk of acute otitis media, non-specific gastroenteritis, and severe lower respiratory tract infections.[12]

Less tendency to develop allergic diseases (atopy)

In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age.[23] However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.[24] Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.[25]

More easily aroused from sleep

Breastfed babies have better arousal from sleep at 2–3 months. This coincides with the peak incidence of sudden infant death syndrome.[26]

Higher intelligence

Studies examining whether breastfeeding in infants is associated with higher intelligence later in life include:

  • Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of 280 low birthweight children at seven or eight years of age.[27] Those who were breastfed for more than eight months had verbal IQ scores 6 points higher (which was significantly higher) than comparable children breastfed for less time.[27] They concluded "These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development."[27]
  • A 2005 study using data on 2,734 sibling pairs from the National Longitudinal Study of Adolescent Health "provide[d] persuasive evidence of a causal connection between breastfeeding and intelligence."[28]
  • In 2006, Der and colleagues, having performed a prospective cohort study, sibling pairs analysis, and meta-analysis, concluded that "Breast feeding has little or no effect on intelligence in children."[29] The researchers found that "Most of the observed association between breast feeding and cognitive development is the result of confounding by maternal intelligence."[29]
  • The 2007 review for the AHRQ found "no relationship between breastfeeding in term infants and cognitive performance."[12]
  • The 2007 review for the WHO concluded "Subjects who were breastfed experienced... higher performance in intelligence tests."[13]
  • Two initial cohort studies published in 2007 suggest babies with a specific version of the FADS2 gene demonstrated an IQ averaging 7 points higher if breastfed, compared with babies with a less common version of the gene who showed no improvement when breastfed.[30] FADS2 affects the metabolism of polyunsaturated fatty acids found in human breast milk, such as docosahexaenoic acid and arachidonic acid, which are known to be linked to early brain development.[30] The researchers were quoted as saying "Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ. But it's not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant."[31] The researchers wrote "further investigation to replicate and explain this specific gene–environment interaction is warranted."[30]
  • In "the largest randomized trial ever conducted in the area of human lactation," between 1996 and 1997 maternity hospitals and polyclinics in Belarus were randomized to receive or not receive breastfeeding promotion modeled on the Baby Friendly Hospital Initiative.[32] Of 13,889 infants born at these hospitals and polyclinics and followed up in 2002-2005, those who had been born in hospitals and polyclinics receiving breastfeeding promotion had IQs that were 2.9-7.5 points higher (which was significantly higher).[32] Since (among other reasons) a randomized trial should control for maternal IQ, the authors concluded in a 2008 paper that the data "provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development."[32]

Diabetes

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.[12][33] Breastfeeding also appears to protect against diabetes mellitus type 2,[12][13][34][35] at least in part due to its effects on the child's weight.[35]

Obesity

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[36] The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.[12][13][37]

Other long term health effects

In one study, breastfeeding did not appear to offer protection against allergies.[38] However, another study showed breastfeeding to have lowered the risk of asthma, protect against allergies, and provide improved protection for babies against respiratory and intestinal infections.[39]

A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.[40]

An initial study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed.[41]

Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants.[13][42] Although a 2001 study suggested that adults who had been breastfed as infants had lower arterial distensibility than adults who had not been breastfed as infants[43], the 2007 review for the WHO concluded that breastfed infants "experienced lower mean blood pressure" later in life[13]. Nevertheless, the 2007 review for the AHRQ found that "the relationship between breastfeeding and cardiovascular diseases was unclear"[12].

Benefits for mothers

Zanzibari woman breastfeeding

Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body[15] and the maternal bond can be strengthened.[9] Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.[44]

Bonding

Breastfeeding helps to strengthen the maternal bond.[9] The hormones released during breastfeeding strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.[45] Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.[46]

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.

Hormone release

Breastfeeding releases oxytocin and prolactin, hormones that relax the mother and make her feel more nurturing toward her baby.[47] Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Pitocin, a synthetic hormone used to make the uterus contract during and after labour, is structurally modelled on oxytocin.[48] Some women experience orgasm during breastfeeding due to the release of oxytocin.[49]

Weight loss

As the fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6 months—can help mothers lose weight.[50] However, weight loss is highly variable among lactating women; monitoring the diet and increasing the amount/intensity of exercise are more reliable ways of losing weight.[51] The 2007 review for the AHRQ found "The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear."[12]

Natural postpartum infertility

A breastfeeding woman may not ovulate, or have regular periods, during the entire lactation period. The period in which ovulation is absent differs for each woman. This Lactational amenorrhea has been used as an imperfect form of natural contraception, with a greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed.[52] It is possible for some women to ovulate within two months after birth while fully breastfeeding.

Long-term health effects

For breastfeeding women, long-term health benefits include:

  • Less risk of breast cancer, ovarian cancer, and endometrial cancer.[8][12][53][54]
  • A 2009 study indicates long duration of lactation (at least 24 months) is associated with a reduced risk of heart disease.[55]
  • Although the 2007 review for the AHRQ found "no relationship between a history of lactation and the risk of osteoporosis"[12], mothers who breastfeed longer than eight months benefit from bone re-mineralisation.[56]
  • Breastfeeding diabetic mothers require less insulin.[57]
  • Reduced risk of post-partum bleeding.[48]
  • According to a Malmö University study published in 2009, women who breast fed for a longer duration have a lower risk for contracting rheumatoid arthritis than women who breast fed for a shorter duration or who had never breast fed.[58]

Organisational endorsements

World Health Organization

“ The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.[7] ”

The WHO recommends exclusive breastfeeding for the first six months of life, after which "infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond."[7]

American Academy of Pediatrics

“ Extensive research using improved epidemiologic methods and modern laboratory techniques documents diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and use of human milk for infant feeding. These advantages include health, nutritional, immunologic, developmental, psychologic, social, economic, and environmental benefits.[8] ”

The AAP recommends exclusive breastfeeding for the first six months of life.[8] Furthermore, "breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child."[8]

Breastfeeding difficulties

Main article: Breastfeeding difficulties

While breastfeeding is a natural human activity, difficulties are not uncommon. Putting the baby to the breast as soon as possible after the birth helps to avoid many problems. The AAP breastfeeding policy says: "Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed."[8] Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.[59] There are some situations in which breastfeeding may be harmful to the infant, including infection with HIV and acute poisoning by environmental contaminants such as lead.[39] Rarely, a mother may not be able to produce breastmilk because of a prolactin deficiency. This may be caused by Sheehan's syndrome, an uncommon result of a sudden drop in blood pressure during childbirth typically due to hemorrhaging. In developed countries, many working mothers do not breast feed their children due to work pressures. For example, a mother may need to schedule for frequent pumping breaks, and find a clean, private and quiet place at work for pumping. These inconveniences may cause mothers to give up on breast feeding and use infant formula instead.

HIV infection

As breastfeeding can transmit HIV from mother to child, UNAIDS recommends avoidance of all breastfeeding where formula feeding is acceptable, feasible, affordable and safe.[60] The qualifications are important. Some constituents of breast milk may protect from infection. High levels of certain polyunsaturated fatty acids in breast milk (including eicosadienoic, arachidonic and gamma-linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in breast milk.[61] Due to this, in underdeveloped nations infant mortality rates are lower when HIV-positive mothers breastfeed their newborns than when they use infant formula. However, differences in infant mortality rates have not been reported in better resourced areas.[62] Treating infants prophylactically with lamivudine (3TC) can help to decrease the transmission of HIV from mother to child by breastfeeding.[63] If free or subsidized formula is given to HIV-infected mothers, recommendations have been made to minimize the drawbacks such as possible disclosure of the mother's HIV status.[64]

Infant weight gain

Breastfed infants generally gain weight according to the following guidelines:

0–4 months: 170 grams per week†
4–6 months: 113–142 grams per week
6–12 months: 57–113 grams per week
† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.

The average breastfed baby doubles its birth weight in 5–6 months. By one year, a typical breastfed baby will weigh about 2½ times its birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.[65] By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.[66]

Methods and considerations

There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche League International also provide advice and support.

Early breastfeeding

In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding.[67] Early breast-feeding is associated with fewer nighttime feeding problems.[68]

Time and place for breastfeeding

Breastfeeding at least every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.[8][not in citation given] Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day.[69] Feeding a baby "on demand" (sometimes referred to as "on cue"), means feeding when the baby shows signs of hunger; feeding this way rather than by the clock helps to maintain milk production and ensure the baby's needs for milk and comfort are being met.[citation needed] However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hindmilk.[70]

"Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain."[71]

"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she can't be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success."[71]

Rooming-in bassinet

Most US states now have laws that allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care permits the baby to stay with the mother and improves the ease of breastfeeding. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring them to go to a special area.

Latching on, feeding and positioning

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Correct positioning and technique for latching on can prevent nipple soreness and allow the baby to obtain enough milk.[72] The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a breastfeeding session, then quickly moving baby onto the breast while baby's mouth is wide open.[73] In order to prevent nipple soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the baby's mouth.[72][74] To help the baby latch on well, tickle the baby's top lip with the nipple, wait until the baby's mouth opens wide, then bring the baby up towards the nipple quickly, so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat, with the baby's tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto. Resist the temptation to move towards the baby, as this can lead to poor attachment.

Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.[75]

The baby may pull away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.

While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn.

When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows.

Exclusive breastfeeding

Two 25ml samples of human breast milk. The left hand sample is foremilk, the watery milk coming from a full breast. The right hand sample is hindmilk, the creamy milk coming from a nearly empty breast.[76]

Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications."[8] National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mixed feeding.[citation needed]

Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is important to recognize the baby's hunger signs. It is assumed that the baby knows how much milk it needs and it is therefore advised that the baby should dictate the number, frequency, and length of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.

While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements.[77] Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.

Expressing breast milk

Manual breast pump

When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.[78]

Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again.

"Exclusively expressing", "exclusively pumping" and "EPing" are terms for a mother who feeds her baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes. Kellymom has a page of links relating to exclusive pumping.[79]

It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4–6 weeks old and is good at sucking directly from the breast.[80] As sucking from a bottle takes less effort, babies can lose their desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4–6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.[citation needed]

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though historically the use of wet nurses was common, some women dislike the idea of feeding their own child with another woman's milk; others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.[81] The transmission of some viral diseases through breastfeeding can be prevented by expressing breast milk and subjecting it to Holder pasteurisation.[82]

Mixed feeding

Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle

Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; with an artificial teat, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can result in the infant preferring the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.

Tandem breastfeeding

Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.

In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully.[83][84][85]

Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.[86]

Extended breastfeeding

Breastfeeding past two years is called "full term breastfeeding" or extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S.[87] Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother.[citation needed]

Shared breastfeeding

Main article: Wet nurse

It used to be common worldwide, and still is in developing nations such as those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.[88] A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry (mahram). Shared breastfeeding can incur strong negative reactions in the Anglosphere;[89] American feminist activist Jennifer Baumgardner has written about her experiences in New York with this issue.[90]

Weaning

Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned when it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Most humans have a mutation that allows the production of lactase throughout life and so can drink milk - usually cow or goat milk - well beyond infancy.[91]

In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this medication posed serious health risks to women such as stroke and seizures, and the U.S. Food and Drug Administration withdrew this indication for the drug in 1994.[92]

History of breastfeeding

Queen Marie Casimire of Poland with children, 1684.
Famille d’un Chef Camacan se préparant pour une Fête ("Family of a Camacan chief preparing for a celebration") by Jean-Baptiste Debret shows a woman breastfeeding a child in the background.
Main article: History of breastfeeding

For hundreds of thousands of years, humans, like all other mammals, fed their young milk. Before the twentieth century, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow or goat milk were not very positive. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this did not have a favorable outcome, either. True commercial infant formulas appeared on the market in the mid 19th Century but their use did not become widespread until after WWII. As the superior qualities of breast milk became better-established in medical literature, breastfeeding rates have increased and countries have enacted measures to protect the rights of infants and mothers to breastfeed.

Sociological factors with breastfeeding

Researchers have found several social factors that correlate with differences in initiation, frequency, and duration of breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status and other factors have been shown to affect a mother’s choice whether or not to breastfeed and how long she breastfeeds her child.

  • Race and culture Singh et al. also found that African American women are less likely than white women of similar socioeconomic status to breastfeed and Hispanic women are more likely to breastfeed. The Center of Disease Control used information from the National Immunization Survey to determine the proportion of Caucasian and African American children that were ever breast fed. They found that 71.5% of Caucasians had breastfed their child while only 50.1% of African Americans had. At six months of age this fell to 53.9% of Caucasian mothers and 43.2% of African American mothers who were still breastfeeding.[citation needed]
  • Income Deborah L. Dee's research found that women and children who qualify for WIC, Special Supplemental Nutrition Program for Women, Infants, and Children were among those who were least likely to initiate breastfeeding. Income level can also contribute to women discontinuing breastfeeding early. More highly educated women are more likely to have access to information regarding difficulties with breastfeeding, allowing them to continue breastfeeding through difficulty rather than weaning early. Women in higher status jobs are more likely to have access to a lactation room and suffer less social stigma from having to breastfeed or express breastmilk at work. In addition, women who are unable to take an extended leave from work following the birth of their child are less likely to continue breastfeeding when they return to work.[citation needed]
  • Other factors Other factors they found to have an effect on breastfeeding are “household composition, metropolitan/non-metropolitan residence, parental education, household income or poverty status, neighborhood safety, familial support, maternal physical activity, and household smoking status.”[citation needed]

Breastfeeding in public

Main article: Breastfeeding in public

Role of Marketing

Controversy has arisen over the marketing of breast milk vs. formula; particularly how it affects the education of mothers in third world counties and their comprehension (or lack thereof) of the health benefits of breastfeeding.[93] The most famous example being the Nestlé boycott, which arose in the 1970's and continues to be supported by high-profile stars and international groups to this day.[94][95]

In 1981, the World Health Assembly (WHA) adopted Resolution WHA34.22 which includes the International Code of Marketing of Breast-milk Substitutes.

See also

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Further reading

  • Baumslag N, Michels DL (1995). Milk, money, and madness: the culture and politics of breastfeeding. Westport, Conn.: Bergin & Garvey. ISBN 0-89789-407-3. 
  • Hausman B (2003). Mother's milk: breastfeeding controversies in American culture. New York: Routledge. ISBN 0-415-96656-6. 
  • Huggins K (1999). The nursing mother's companion (4th ed.). Boston, Mass.: Harvard Common Press. ISBN 1-55832-152-7. 
  • Pryor G (1997). Nursing mother, working mother: the essential guide for breastfeeding and staying close to your baby after you return to work. Boston, Mass.: Harvard Common Press. ISBN 1-55832-116-0. 
  • Torgus J, Gotsch G (2004). The womanly art of breastfeeding (7th ed.). Schaumburg, Ill.: La Leche League International. ISBN 0-912500-98-0. 

External links

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Translations: Breast-feed
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Home > Library > Literature & Language > Translations

Dansk (Danish)
v. tr. - amme, give mælk

Nederlands (Dutch)
borstvoeding geven

Français (French)
v. tr. - allaiter

Deutsch (German)
v. - stillen

Ελληνική (Greek)
v. - θηλάζω

Italiano (Italian)
allattare al seno

Português (Portuguese)
v. - amamentar

Русский (Russian)
кормить грудью

Español (Spanish)
v. tr. - dar de mamar, amamantar, dar el pecho

Svenska (Swedish)
v. - amma

中文（简体）(Chinese (Simplified))
以母乳抚育, 哺乳

中文（繁體）(Chinese (Traditional))
v. tr. - 以母乳撫育, 哺乳

한국어 (Korean)
v. tr. - 아이에게 젖을 먹이다

日本語 (Japanese)
v. - 母乳を与える, 母乳で育てる

العربيه (Arabic)
‏(فعل) رضاعه طبيعيه‏

עברית (Hebrew)
v. tr. - ‮היניקה‬

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Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
Food and Fitness. Food and Fitness: A Dictionary of Diet and Exercise. Copyright © 1997, 2003 by Oxford University Press. All rights reserved.  Read more
Psychoanalysis. International Dictionary of Psychoanalysis. Copyright © 2005 by The Gale Group, Inc. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Breastfeeding".  Read more
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