BREASTFEEDING

Updated: Jan 26

Breastfeeding is the best way to provide the necessary nutrients for infants.

The World Health Organization (WHO) defines breastfeeding as the best way to provide the necessary nutrients to children to ensure healthy growth and development. Exclusive breastfeeding is when the infant is given breast milk from the mother or another woman, without any other solid or liquid food (including water), which should be provided for the first 6 months of life. While in complementary breastfeeding, breast milk is provided, including solids, semisolids and non-human milk as formulas (1). Complementary breast feeding should be provided until 2 years of age. Likewise, breastfeeding on demand during the day and night is recommended, avoiding the introduction of bottles and pacifiers (3).

Exclusive breastfeeding for the first 6 months of life. Complementary breastfeeding until 2 years of age.

Benefits of breastfeeding

Infant

Breastfeeding is the ideal way to provide the necessary nutrients for children as it has been associated with several benefits among which is a decrease in gastrointestinal diseases by 64%, and a protective effect of two months after stopping breastfeeding has been identified. They provide nutrients and enzymes that facilitate digestion and there is a greater digestive maturation. Breastfed children are less likely to suffer from diarrhea, respiratory infections, constipation, tooth decay and food allergies during the first years of life. It has also been shown that these children have better neurological development. On the other hand, in the long term, in adulthood, they are less likely to suffer from type 1 diabetes, cardiovascular risks and obesity (2).

Benefits of breast milk in infants: Less likelihood of diarrhea, respiratory infections, constipation, tooth decay and allergies.

Mother

As for mothers, important benefits have been observed such as: faster recovery, less risk of hypertension and postpartum depression, less probability of ovarian and breast cancer; it contributes to bone mineralization, faster weight loss and a greater bond with the mother. Breastfeeding also helps the family's economy, since there is no need to buy milk formulas, which are expensive, or to generate long-term expenses due to some diseases that both mother and child may present in case of using milk formulas (3).

Breastfeeding women have a lower risk of postpartum depression, ovarian and breast cancer and faster weight loss.

Artificial feeding

Artificial formulas may affect infants in the short or long term.

Currently, there are a large number of artificial formulas that seek to resemble as closely as possible the mother's milk. Despite the fact that breast milk is ideal for feeding infants, artificial feeding is used without considering some negative effects in the short and long term. Those children whose growth and health are compromised by formula feeding. Similarly, there is a higher frequency of suffering from more serious diseases such as diarrhea, pneumonia, respiratory infections, food allergies and asthma during the first years of life, while in adulthood they may present diabetes, cardiovascular risks, obesity, celiac disease, ulcerative colitis and leukemia. Therefore, the incorporation of artificial feeding is not a good option for infant feeding (2).

Particular cases for the use of artificial lactation

La mayoría de las mujeres pueden amamantar de manera adecuada, pero una pequeña parte de ellas no puede amamantar de manera temporal o permanente dependiendo las condiciones que presente el recién nacido y la madre. Por lo tanto, de acuerdo con la OMS el uso de lactancia artificial es recomendado en casos particulares: en los lactantes cuando presentan algunas alteraciones como galactosemia clásica, enfermedad de orina en jarabe de arce o fenilcetonuria, se debe optar por alguna fórmula especial dependiendo la afección que presente. De igual manera, en caso de recién nacidos con bajo peso (<1500 g) o nacidos antes de las 32 semanas de gestación se puede optar por una alimentación mixta donde se proporciona lactancia materna y artificial dependiendo las características de cada recién nacido. En cuanto a las madres, se debe valorar por un médico ante la presencia de VIH, y de manera temporal suspender en caso de que la madre presente alguna enfermedad que le impida proporcionar leche materna al niño o cuando la madre ingiera medicamentos específicos. Por otra parte, no en todos los casos se impide el amamantamiento por enfermedades que presenta la madre como es el caso de hepatitis B y C, mastitis y tuberculosis. Por lo tanto, se debe continuar proporcionando leche materna al niño para brindarle los nutrientes necesarios garantizando un adecuado crecimiento y desarrollo del mismo (4). Todo esto bajo prescripción y vigilancia médica.

Milk preservation to maintain breastfeeding

Ideally, the infant should be provided with breast milk directly from the mother's breast, but if this is not possible, it is recommended that breast milk be expressed and stored at an appropriate temperature. The temperature of breast milk is important to avoid bacterial growth, since warmer temperatures are negative for good preservation of breast milk. Breast milk can be stored at room temperature of 10-29 °C for 3 to 4 hours. When refrigerated, it can be stored for 48 to 72 hours at a temperature of 4 °C. Also a good form of long-term storage is through freezing, it is safe when it is at a temperature of -4 to -20 °C and can last up to 6 weeks. In these last two forms of storage it is important to place the milk container at the back of the appliance to avoid bacterial growth due to temperature changes when opening the refrigerator or freezer. In the same way, a label should be placed with the date and in volumes per infant feedings. Breast milk should be used immediately after freezing, so it should be thawed overnight or the bottle should be placed under warm running water or in a container of warm water. It is not recommended to use the microwave and once thawed it should not be refrozen. Likewise, hand washing with soap and water or antiseptic before breastfeeding or expressing milk is essential to prevent the transmission of viruses and bacteria to the infant (1).

Storage of breast milk: Room temperature (10-29°C) for 3 to 4 hours. Refrigeration (4°C) for 48 to 72 hours. Freezing (-4 to -20°C) up to 6 months.

Common practical problems with breastfeeding

There are several problems for breastfeeding infants due to psychological factors, specific factors that affect the breast such as some diseases and, more frequently, latching problems and an inadequate breastfeeding technique (5), therefore according to the Mexican Social Security Institute (IMSS) it is recommended to provide women with guidance for a successful breastfeeding technique as described below (8):

Before breastfeeding, wash hands with soap and water.

It is not necessary to wash the breasts at each feeding; daily bathing and changing clothes is enough.

Get into a comfortable position and bring the baby to the breast. Once the infant's mouth opens, insert the nipple and part of the areola.

Hold the breast in a "C" shape with the thumb above the areola and the remaining fingers below. Make sure the baby's lips are facing outward and wide open, covering as much of the areola as possible.

Breastfeeding on demand.

Before giving the other breast, the air should be removed by holding the baby on the shoulder and patting the baby's back until he/she burps.

Place it on the other breast and repeat the previous steps.

At each feeding start with the same breast you started with last time.

Not knowing if babies are being given adequate food is a frequent question that mothers often have. The IMSS provides different signs that indicate if the baby is drinking enough milk for adequate growth such as: 750 g weight gain in the first month of life, wetting the diaper after each feeding, sleeping peacefully after feeding and the mother should feel a sense of rest as a sign of breast emptying.

Popular beliefs and truths about breastfeeding

MYTHS:

Mothers must drink a lot of milk to produce breast milk: There is no scientific evidence that when the mother consumes milk, breast milk production increases, but it is true that if the baby sucks properly, the hormone prolactin is released, which is a producer of breast milk (6).

Beer increases the production and quality of breast milk: alcohol will not increase breast milk, on the contrary, it decreases it by 10 to 15% due to a decrease in the hormone oxytocin (6).

Mothers should eat twice as much to increase breast milk: You should not eat for two, caloric needs depend on each woman, you should only add 500 kcal/day to your necessary requirement (in some cases not even that) so it does not indicate eating for two (6).

Breastfeeding increases myopia: There is no scientific evidence that breastfeeding increases myopia (6).

Breastfeeding mothers should not be X-rayed: radiation does not modify the characteristics of breast milk and does not generate any risk (6).

Breast-feeding should be discontinued if the mother becomes pregnant again: Breastfeeding should not be discontinued, nor can it cause miscarriages. Therefore, breastfeeding should be continued if you become pregnant again. What it can cause are changes in the composition and production of breast milk, but it is still high in nutrients and immunological factors (6).

Women with small breasts and implants have less milk production: Milk production is not less in women with small breasts because the glandular tissues, responsible for milk production, are almost the same size in all women. On the other hand, the implant does not compromise breastfeeding, women can have a normal breast milk production (6).

Colostrum should be discarded: Colostrum is very important to provide to the infant during the first days after birth as it contains a high supply of immunoglobulins that protect the infant from infections and allergies and therefore should not be discarded (6).

TRUTHS:

Breastfeeding can cause hair loss: During gestation estrogens increase which are hormones that stimulate hair growth and after delivery they begin to decrease, therefore during the first 4 months there is a sudden hair loss (6).

Breastfeeding protects the baby against infections: Breastfeeding provides the necessary nutrients for babies, decreasing the probability of contracting gastrointestinal diseases by 64% (2).

Breastfeeding helps to regain the mother's weight faster: Breastfeeding is beneficial for mothers because they regain their pre-pregnancy weight faster, which reduces the probability of suffering from obesity and overweight (7).

References

Mexican Institute of Social Security. Breastfeeding: Mother with illness treated with medication. Mexican Institute of Social Security; 2013. p. 10-29.
Brahm P, Valdés V. Benefit of breastfeeding and risk of not breastfeeding. Rev Chil Pediatr. 2017;88(1):7-14.
World Health Organization [Internet]. World Breastfeeding Week. World Health Organization. 2018 [cited 2020 July 29]. Retrieved from: https://www.paho.org/hq/.
World Health Organization. Acceptable medical rationale for the use of breastmilk substitutes. World Health Organization; 2009. p. 4-5.
Tomico P. Problems in breastfeeding. AEPapa. 2020: 451-462.
Vargas Z, Becerra B, Balsero O, Meneses B. Breastfeeding: myths and truths. Rev Fac Med. 2020; 68(4): ISSN Online: 2357-3848.
Aguilar CM, Sánchez LM, Madrid BN, Mur VN, Expósito RM, Hermoso RE. Breastfeeding as prevention of overweight and obesity in the child and adolescent; systematic review. Nutr Hosp. 2015;31(2):606-620.
Mexican Institute of Social Security [Internet]. Lactancia. [Cited 2021 January 14]; Available from: http://www.imss.gob.mx/salud-en-linea/.