Breastfeeding
Breastfeeding is recommended. Advantages of breastfeeding include convenience, digestibility, transfer of antiviral and antibacterial antibodies, decreased risk of allergic phenomena, maternal-infant bonding, lower incidence of regurgitation, and no constipation. In addition, breastfeeding delays and reduces the incidence of infectious diseases and atopic diseases such as eczema, allergies, and asthma, and it may help prevent obesity and type 1 diabetes. Breastfeeding has increased in frequency from a low point of 52% in the late 1980s to two thirds of postpartum women at discharge today. Breastfeeding needs to be encouraged. Education and planning should begin optimally during the early part of pregnancy. Lactation assistance by breastfeeding-knowledgeable health care professionals after birth is important for first-time mothers. After delivery, before it is assumed that milk production is insufficient for the infant, health care professionals should consider errors in feeding techniques, remediable maternal factors, such as lack of confidence or lack of support, anatomic anomalies in the mother or infant, and physical disturbances in the infant. Appropriate latch-on is important to prevent nipple soreness, mastitis, and abandonment of breastfeeding (Fig. 98-1). Encouraging hospitals in our communities to be “baby-friendly” can also increase the number of successful breastfeeding mothers. Feeding should be on demand; although erratic in the first few months, infants tend to regulate themselves after a short time.
Fig. Appropriate latch-on is important to prevent nipple
soreness, mastitis, and abandonment of breastfeeding
Vitamins, fluoride, and iron supplements
Vitamins are unnecessary for most babies, particularly if maternal supplies during pregnancy were adequate. If the baby is not exposed to sufficient sunlight or is darkly pigmented, supplemental vitamin D is recommended. The American Academy of Pediatrics now recommends 400 IU daily for all infants older than 2 months and, on the basis of consensus opinion, supplementation for breast-fed infants. Formula-fed infants generally do not need supplementation. Fluoride supplementation is unnecessary if the community water supply contains 1 ppm or more fluoride. Iron supplements (in the form of iron-fortified food) may be introduced at the age of 6 months to reduce the possibility of anemia.
Solid foods
Breast milk is an excellent food for at least the first year of life, and it may be continued as long as both mother and child like. Solid foods should be introduced at approximately 3-4 months of age; introduce one new food every 1 or 2 weeks.
Colostrum
The advantages of human colostrum and the immunologic benefits of human milk are innumerable. Colostrum provides macrophages as well as viral and bacterial antibodies of the secretory IgA class. Colostrum also supplies immunomodulating agents, such as complement, lysozyme, lactoferrin, cytokines, and interleukins.
Breastfeeding problems
Common breastfeeding problems include difficulty with latch-on, positioning, mastitis, and inadequate milk production. Most of these problems can be prevented with good education and observation of the infant feeding before discharge. Close follow-up after discharge at 48 to 72 hours and availability of a health worker to counsel the mother will increase the likelihood of successful breastfeeding.
Growth and development
The minimum standard for the neonate is a weight gain of 30 g/day. All infants should regain their birth weight by 10 to 14 days. Frequent wet diapers and stools, coupled with return to birth weight, are good measures of adequate feeding at the 2-week visit.
Drugs used during lactation
As a general rule, any drug that can be given safely to a neonate is probably safe to use during breastfeeding. The American Academy of Pediatrics publishes a review of drugs and chemicals that can be safely used during lactation. Although the “jury is still out” in terms of studies, the prime contraindication to breastfeeding in the United States and developed countries is maternal human immunodeficiency virus infection.
Suggested Reading
American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–e841.
Casey C, Dawson D, Neal L. Vitamin D supplementation in infants, children, and adolescents. Am Fam Physician. 2010;81:745–748.
Fulhan J, Collier S, Duggan C. Update on pediatric nutrition: breastfeeding, infant nutrition, and growth. Curr Opin Pediatr. 2003;15:323–332.
Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical professions. ed 7. Maryland Heights: Elsevier Mosby; 2011.
Newton E. Physiology of lactation and breastfeeding. In: Gabbe SG, ed. Obstetrics: normal and problem pregnancies. ed 4. New York: Churchill Livingstone; 2002.
Powers N. How to assess slow growth in the breastfed infant. Pediatr Clin North Am. 2001;48:345–363.