Introduction
Good nutrition is essential for the growth and development that occurs during an infant’s first year of life. When developing infants are fed the appropriate types and amounts of foods, their health are promoted. Positive and supportive feeding attitudes and techniques demonstrated by the caregiver help infants develop healthy attitudes toward foods, themselves, and others.
In 2001 the World Health Organization (WHO) released global recommendations for infant feeding practices. WHO recommends that infants be exclusively breastfed for the first six months using on-demand feeding and with initiation within the first hour of life. Nutritionally appropriate and safe complementary foods should be introduced after this time. Breastfeeding should be encouraged for up to two years of age or longer (Kramer & Kakuma, 2007).
Breastfeeding is the natural and optimal way of providing appropriate nutrition to infants. Breastfeeding also plays an invaluable role in the reproductive process and provides many health benefits to both mother and infant (Kramer & Kakuma, 2007). These benefits include immune enhancement, optimal cognitive and physical development, and strengthened psychosocial skills. In resource poor nations, breastfeeding is especially important given it confers a hygienic source of renewable energy and remains a secure source of macro and micronutrients despite economic or environmental conditions. The timing of introducing complementary foods and the types and safety of these foods are of direct impact on infants’ wellbeing (WHO, 2006).
Breastfeeding
Breastfeeding is an integral part of infant feeding and is the natural form of supplying nourishment to a mammalian infant. In a recent study titled “Preliminary Data from Demographic and Health Surveys on Infant Feeding in 20 Developing Countries,” by Marriott, Campbell, Hirsh and Wilson in 2007 determined that of the 20 countries studied, 99.6% of 0 to 6 and 87.9% of 6 to 12 month old infants were breastfed. Breast milk has been optimally adapted to meet the physiological and psychological needs of both mother and child. It provides total food security for infants up to six months of age and in the case of emergencies, provides the only reliable source of nutrition for infants (United States Agency for International Development [USAID], 2006).
What nursing mothers should expect when breastfeeding
Although breastfeeding is natural, it also takes patience and practice. The more the nursing mother breastfeed, the more milk they will produce.
- New babies who are breastfed usually nurse from 15-20 minutes at each breast. The length of feedings will vary according to the baby’s appetite and growth.
- Babies may want to nurse about every 2-3 hours or 8-12 times in 24 hours. As the baby gets older, he or she will eat more at one time and the mother will be able to nurse less often.
- When babies suddenly want to eat more than usual, they are likely going through a growth spurt. Infants should be fed more often during these times and should not be forced to follow a strict feeding schedule.
- For the first 4-6 months, breast milk should be the baby’s only food. When cereal is given too early, it is hard to digest and can cause food allergies.
- Starting solids too soon will naturally decrease the baby’s intake of breast milk. Breast milk is better for a baby because it contains more calories and nutrition needed for growth.
Benefits of breastfeeding to infant
When breastfed appropriately, benefits to infants may include reduced risk of diarrhoeal and gastrointestinal illnesses, allergies, acute respiratory infections, otitis media, bacterial meningitis, atopic disease, childhood asthma, and childhood leukemia (Kramer & Kakuma, 2007). There is evidence to suggest that breastfed infants have enhanced cognitive development that is sustained throughout childhood. Breast milk’s immunological properties may also increase protection from infectious disease and may reduce risk for long-term conditions like diabetes mellitus, Crohn’s disease and lymphoma; breast milk may provide protective antibodies and may stimulate and infant’s immune system to overcome these diseases. This protective effect is enhanced with greater breastfeeding duration and exclusivity. However, exclusive breastfeeding beyond the recommended six months has been reported to be associated with a higher risk of malnutrition (Fawzi, Herrera, Nestel, Amin & Mohamed, 2008).
It is widely accepted that breastfed infants develop a closer bond with their mother and that this has positive implications in the psychosocial development of an infant. Furthermore, there are strong indications that the benefits of appropriate breastfeeding may not only be experienced in the short term but may extend throughout the lifespan (Fawzi, et al., 2008).
Complementary feeding
Of the three major components of infant feeding, (breastfeeding, complementary feeding, weaning) complementary feeding is often regarded as the most complex. A mother’s complementary feeding practices are determined be a number of factors often out of her immediate control including local water and food availability and accessibility, employment, and environmental conditions. Knowledge of appropriate timing of introduction of foods and types of foods is another factor often complicated by lack of resources. (Fawzi, et al., 2008) reported of the 20 countries studies, 21.9% of mothers reported feeding 0- to 6- month old infants some type of solid food, and 80.1% of mothers reported feeding solids to 6 to 12 month olds. The same study also showed that other types of milks, other liquids and solid foods were much more commonly administered than commercial infant formulas in the countries studied.
WHO recommends starting complementary feeding from the age of six months with continued breastfeeding up to two years of age or longer. Appropriate foods should be matched with the nutritional needs of the infant so that adequate amounts of energy, protein and micronutrients are provided. Also recommended is that all foods given are hygienically stored and prepared to minimize risk of food borne pathogens. WHO’s last recommendation regarding complementary feeding is concerned with an individual infant’s feeding behaviors. Infants express hunger, satiety, and preferred feeding methods through a variety of behaviors from which a mother acts upon according to her interpretation. Infants do not necessarily have the capability to choose which types of foods and beverages they should consume; this responsibility usually lies with the mother (WHO, 2006).
Effects of complementary feeding on infants
Inappropriate complementary feeding practices are a major cause of the onset of malnutrition in infants. The incidence of malnutrition rises sharply during the period from six months to 18 months of age in most countries, and the deficits acquired at this age are difficult to compensate for later in life. From six months onward, when breast milk alone is no longer sufficient to meet all the nutritional requirements, infants enter a particularly vulnerable period of complementary feeding during which they make a gradual transition to eating family foods. Poor nutrition intake during this critical period of development can increase the risk of morbidity and mortality and can result in compromised growth and cognitive function in later years (Simondon, 2010).
In many parts of the world, lactation amenorrhea is the major factor in birth spacing, particularly in regions lacking in birth control prophylaxis or family planning programs. A positive association between the early introduction of complementary foods and the rapid resumption of ovulation has been documented. Increasing the length of time between births is important given that a newborn often takes a mothers’ time away from other infants. This concomitantly results in cessation of breastfeeding of existing infants or introducing inappropriate foods too early, which has been known to lead to increased morbidity and mortality in infants (Simondon, 2010).
Common deficiencies of complementary foods
Complementary foods are often deficient in energy, protein and micronutrients including calcium, iron, zinc, vitamin A, riboflavin. Poor bioavailability of these micronutrients further compounds this problem. Complementary foods are often used as substitutes instead of supplements to breast milk, and are most always of lesser nutritional quality. For example, gruels are commonly given as one of the first complementary foods in many parts of the world. These are grain powders mixed with animal milks or water which are high in carbohydrates but low in protein and micronutrient quality. In addition, water and animal milks may be unsafe or contaminated and complementary foods are often not stored nor prepared in a safe manner (Gibson, Ferguson, & Lehrfeld, 2008).
Vitamin/mineral supplementation for breastfed infants
- Breast milk provides complete nutrition for the first 4-6 months of life, with the exception of Vitamin D. So the nursing mother should contact their care provider who may recommend a Vitamin D supplement for their breastfed infant.
- Beginning at 6 months of age, the breastfed, full-term infant usually requires an additional iron source. The addition of iron-fortified cereals is usually adequate to meet iron requirements. In healthy breastfed infants, an additional source of iron given before age 6 months is unnecessary.
- Fluoride supplementation is not needed before 6 months of age. After 6 months of age, fluoride may be prescribed for the breastfed infant who is not given additional fluoridated drinking water or formula mixed with fluoridated drinking water.
- For infants who were exclusively breastfed, after they turns 6 months old, the nursing mother should ask her health care provider about vitamin and mineral supplementation.
Weaning
Mothers choose to wean their infants for a variety of reasons including traditional beliefs, nutritional status of the infant, new pregnancy or onset of illness. When weaned too early, there is a possibility the infant cannot ingest enough food to attain adequate macro and micronutrients which can lead to under nutrition, failure to thrive and death. When weaned too late, breast milk may delay consumption of foods that are more nutritionally appropriate for the infant’s need and may also result in poor nutritional status. WHO and UNICEF recommend weaning infants at two years of age or older based upon studies that indicate breast milk is not an adequate source of nutrition beyond this age and that prolonged breastfeeding can reduce total food intake and thus predispose to malnutrition (WHO, 2006).
The amounts of iron, zinc, copper, and potassium decline in women’s breast milk over time. Both UNICEF and WHO recognize the additional benefits to infant and mother from gradual weaning, meaning the slow cessation of breastfeeding rather than an abrupt switch. Gradual weaning allows adequate time for an infant’s immune system to become familiar with microbial pathogens whereas abrupt weaning can expose an infant to harmful amounts of microbial pathogens that its body has not yet been prepared to confront. Safety and sanitation of foods, beverages, and utensils used to feed infants is of utmost importance given that microbial pathogens are the leading causes of infant morbidity and mortality from gastrointestinal and diarrheal diseases in children under the age of five (Motarjemi, 2005).
References
Fawzi, W. W., Herrera, M. G., Nestel, P., Amin, A. E., & Mohamed, K. A. (2008). A longitudinal study of prolonged breastfeeding in relation to child undernutrition. International Journal of Epidemiology, 27, 255-260.
Gibson, R. S., Ferguson, E.L., & Lehrfeld, J. (2008). Complementary foods for infant feeding in developing countries: Their nutrient adequacy and improvement. European Journal of Clinical Nutrition. 52, 164-110.
Kramer, M.S. & Kakuma, R. (2007).The optimal duration of exclusive breastfeeding: a systematic review. Advanced Experimental Medical Biology Journal 554:63-77.
Motarjemi, Y. (2005). Research Priorities on Safety of Complementary Feeding. Pediatrics, 106 (5), 1304-1305.
Simondon, K. (2010). Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa. American Journal of Clinical Nutrition, 78:154-161.
United States Agency for International Development [USAID] (2006). Breastfeeding USAID background paper. Available at http://usaid.gov/policy/ads/200/212sab.pdf. Accessed February 2nd, 2015.
WHO (2006). New data on the prevention of mother-to-child transmission of HIV and their policy implications: conclusions, and implications. WHO Technical Consultation on Behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to- Child Transmission of HIV, Geneva 11-13 October, 2005. Report No. WHO/RHR/01.28 2005.WHO Geneva, Switzerland.
