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Policy Gradually Able to Eat Normal Family Food (Around One Year)

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Policy Gradually Able to Eat Normal Family Food (Around One Year) ■ Policy gradually able to eat normal family food (around one year). The latter period is also referred to as weaning. The term weaning does not denote termination of breastfeeding. Appropriate feeding is crucial for IAP POLICY ON the healthy growth and development of INFANT FEEDING the infant. However, lack of confidence and widespread ignorance and miscon- ceptions frequently result in improper management of infant feeding. The pro- minent areas of concern include discar- ding or minimal feeding of colostrum or delayed initiation of breastfeeding by Background nearly 80% of mothers, non exclusive breastfeeding by 85-90% in the first four Appropriate nutritional practices months of life, unnecessary utilization play a pivotal role in determining opti- of commercial infant milk foods and mal health and development of infants. animal milks, early termination of Concerned by the lack of uniform breastfeeding and premature or delayed guidelines for appropriate infant feed- introduction of semi-solids which may ing practices in the Indian context, the be contaminated, low in caloric density IAP Subspecialty Chapter on Nutrition and fed less frequently. These inept conducted a Workshop to define a feeding practices, directly or indirectly, Policy on Infant Feeding (Appendix). contribute substantially to infectious Subsequently, these recommendations illnesses, malnutrition and mortality in were endorsed as the official Indian infants. Academy of Pediatrics Policy on Infant Feeding and as National Guidelines on The Policy on Infant Feeding aims at Infant Feeding by the Food and Nutri- promotion of suitable feeding practices tion Board, Department of Women and to advance child care, growth and Child Development, Ministry of Human development, reduce the prevalence of Resource Development, Government of protein energy malnutrition (PEM), India. Vitamin A deficiency and infectious diseases, particularly diarrhea, and Contents of the IAP Policy on Infant improve survival. The Policy focuses on Feeding the strategy of educating and motiva- Ideal infant feeding comprises exclu- ting the families to adopt proper infant sive breastfeeding for 4 to 6 months fol- feeding methods through the existing lowed by sequential addition of semi- health infrastructure and other develop- solid and solid foods to complement ment programmes for women and (not replace) breastmilk till the child is children. POLICY A. Appropriate Infant Feeding management of breastfeeding. In the Practices last trimester of pregnancy, breast and nipples should be examined and rele- I. Breastfeeding vant advise given. Expectant mothers 1. Advantages of Breastfeeding should be counseled to eat an extra helping of the family food with some It is a proven scientific fact that all green vegetables. Additional rest of half commercial infant milk foods and ani- to one hour and wherever possible, mal milks are inferior to breastmilk: switching to relatively lighter work (i) Maternal milk is nutritious food for during the last trimester should be infants which is readily available, propagated. simple to feed, hygienic, develops emo- tional bonding and prevents allergic dis- 3. Starting Breastfeeds orders; (ii) Breastfeeding protects against several infections including Practically all mothers, including diarrhea and respiratory infections, and those with mild to moderate chronic saves lives. An exclusively breastfed malnutrition, can successfully breast- infant is about 14 times less likely to die feed. Soon after delivery, the mother from diarrhea, 3 to 4 times less likely to should be allowed to keep the newborn die from respiratory disease and 2 to 3 with her (rooming-in). After a normal times less likely to die from other infec- delivery, babies should receive the first tions than a non breastfed infant; breastfeed as soon as possible and pre- (iii) Breastmilk is much more economi- ferably within one hour of birth. During cal than artificial milk or powdered milk this period and later, the normal new- food—the average cost of feeding a 6 born should not be given any other fluid month old infant for one month on or food like honey, "ghutti", animal or infant formula may even be equal to the powdered milk, tea, water, glucose average monthly per capita income; water, etc. since these are potentially (iv) "Exclusive" breastfeeding exerts harmful. strong contraceptive effect in the first It is essential that the baby gets the 4-6 months post partum; (v) Maternal first breastmilk called colostrum which benefits include earlier termination of is thicker and yellower than later milk post partum bleeding and protective and comes only in small amounts in the effect against breast and ovarian cancer. first few days. Colostrum is all the food 2. Preparation for Breastfeeding During and fluid needed at this time—no Pregnancy supplements are necessary, not even water. The expectant mothers, particularly primiparas and those experiencing diffi- The mother, especially with the first culties with lactation management ear- birth, may need help in the proper posi- lier, should be motivated and prepared tioning for breastfeeding. Breastfeeds to exclusively breastfeed. This should be should be given as often as the baby achieved by educating, through a per- desires and each feed should continue sonal approach, about the benefits and for as long as the infant wants to suckle. 156 INDIAN PEDIATRICS VOLUME 32-FEBRUARY 1995 After a cesarean section, breastfeed- 6.2. Common Illnesses in the Infant ing should be started as soon as possible Breastmilk is the most easily diges- and preferably within z4 hours of deli- tible food for an ill baby. Feeding very. The mother will need help to put human milk is actually beneficial in the baby to the breast for a day or two. common infantile ailments including 4. Exclusive Breastfeeding diarrhea and acute respiratory infec- tions. Breastfeeding must, therefore, be During the first few months and as ensured during such illnesses. The child far as possible, till the age of 4-6 months, may suckle less vigorously or for a "exclusive" breastfeeding should be prac- shorter time and should receive the ticed; young infants do not require any feeds at more frequent intervals. How- additional food or water or any other ever, breastfeeding and for that matter, fluid such as tea, herbal water, glucose any type of feeding should not be water, fruit drinks, etc. Breastmilk alone attempted in critically ill infants. is adequate to meet the hydration re- quirements even under extremely hot 6.3. Illness in Mother and dry summer conditions of the coun- Most common maternal illnesses do try. not require discontinuation of breast- 5. Diet of Lactating Mother feeding. Breastfeeding is recommended even with mastitis, breast abscess and A lactating woman should be other infectious illnesses including uri- advised to eat an extra helping of the nary tract infection, tuberculosis, family food and regular consumption of human immunodeficiency virus (AIDS), green leafy vegetables. There is no need hepatitis and other viruses. However, to avoid any specific foods; however, physically incapacitating systemic ill- use of excessive caffeine, tobacco, and nesses may prevent or necessitate dis- alcohol, etc. should be discouraged. continuation of breastfeeding. Psychosis 6. Important Special Situations is a contraindication for breastfeeding on account of abnormal maternal beha- 6.1. Low Birth Weight Infants vior. In such situations, wherever Mother's milk is the best food for the feasible, the breasts should be emptied low birth weight babies. The borderline frequently to maintain lactation. term and growth retarded low birth 6.4. Drug Intake in Mother weight babies can suckle fairly well at the breast and should be fed on Drug therapy should be avoided in demand. However/ low birth weight lactating mothers and when necessary, a and other high risk infants who cannot safer alternative should be prescribed. suckle, should be given expressed Drug intake should preferably be timed breastmilk in preference to formula during or immediately after breastfee- feeds by appropriate techniques such as ding. Majority of the commonly used clean cup and spoon, tubes, "paladai", preparations are compatible with safe etc. The child should be put directly to breastfeeding. Only a few drugs necessi- the breast as soon as possible. tate discontinuation of breastfeeding 157 POLICY like anti cancer and anti thyroid frequency of feeding and low calorie therapy, radioactive preparations, ergot, density of the additional foods. gold salts, lithium, etc. 2. Timing of Introduction of Semi-solids 6.5. Breastfeeding Substitues Semi-solid foods- to supplement If a mother can not for some reason breastmilk should be introduced bet- exclusively breastfeed her young infant ween four to six months of age and pre- (below 4 to 6 months age), for example a ferably at six months in poor communi- working mother, her expressed milk ties. Within this age range, the indi- should be given to the baby in prefe- vidual decision should be guided by the rence to other animal or formula milks. growth performance and physiological maturation of the infant. To minimize Rarely, if it is unavoidable—at least any interference with the normal course partially—to give non human milk in the of breastfeeding, semi-solid foods first 4 to 6 months of life, undiluted milk should preferably be given between normally consumed by the family breastfeeds. should be utilized and commercial infant milk foods should be strongly 3. Continuation of Breastfeeding discouraged. In infants, part of exces- At first breastmilk is the baby's main sive fat in buffalo's milk should be food and the weaning diet is extra. removed by separating the cream from Later, even when more semi-solid food milk after boiling and cooling to room is added, breastmilk still continues to temperature. Young infants who are remain an important component of the solely on cow's or buffalo's milk need infant's diet. Breastfeeding should con- additional plain water supplementation. tinue for as long as feasible and prefer- A clean cup and spoon should be used ably well into the second year of life.
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