Breastfeeding - Ten Steps to Successful Breastfeeding - UNICEF/WHO Baby-Friendly Hospital Initiative (BFHI)

Complementary Feeding

What every family and community has a right to know

Breastmilk alone is the best food and drink for an infant for the first six months of life. No other food or drink, not even water, is usually needed during this period.
Newborn babies should be given to the mother to hold immediately after delivery. They should have skin-to-skin contact with the mother and begin breastfeeding within one hour of birth.
Almost every mother can breastfeed successfully. Breastfeeding the baby frequently causes production of more milk. The baby should breastfeed at least eight times daily, day and night, and on demand.
Breastfeeding helps protect babies and young children against dangerous illnesses. It also creates a special bond between mother and child.
Bottle feeding and giving a baby breastmilk substitutes such as infant formula or animal milk can threaten the baby's health and survival. If a woman cannot breastfeed her infant, the baby can be fed expressed breastmilk or, if necessary, a quality breastmilk substitute from an ordinary clean cup.
If a woman is infected with HIV, there is a risk that she can pass the infection to her infant through breastfeeding. In the first six months, this risk is much greater if the infant is fed both breastmilk and other liquids and foods than if fed breastmilk alone. Therefore, it is recommended that the baby receives breastmilk alone for the first six months, unless it is acceptable, feasible, affordable, sustainable and safe to give breastmilk substitutes (infant formula) exclusively.
A woman employed away from her home can continue to breastfeed her child. She should breastfeed as often as possible when she is with the infant and express her breastmilk when they are apart so that another caregiver can feed it to the baby in a clean and safe way.
After 6 months of age, when babies begin to eat foods, breastfeeding should continue for up to two years and beyond because it is an important source of nutrition, energy and protection from illness.

Facts for Life: Breastfeeding - breastfeeding.factsforlife.org

Why it is important • All key messages • Resources

Supporting information for key messages: 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

Breastfeeding - the First 6 Months of Life

Increasing optimal breastfeeding practices could save an estimated 1.5 million infant lives annually. Up to 55 percent of infant deaths from diarrheal disease and acute respiratory infections may result from inappropriate feeding practices. Optimal feeding for sustained child health and growth includes initiation of breastfeeding within the first hour of life, exclusive breastfeeding for six months, timely complementary feeding with appropriate foods, and continued breastfeeding for two years and beyond.

During the first 6 months of life, infants should be exclusively breastfed. This means that the healthy baby should receive breastmilk and no other fluids, such as water, teas, juice, cereal drinks, animal milk or formula. Exclusively breastfed babies are much less likely to get diarrhoea or to die from it than are babies who are not breastfed or are partially breastfed. Breastfeeding also protects against the risk of allergy early in life, aids in child spacing and provides protection against infections other than diarrhoea (e.g. pneumonia). Breastfeeding should be continued until at least 2 years of age. The best way to establish the practice is to put the baby to the breast immediately after birth and not to give any other fluids.

BREASTFEEDING

Best for baby
Reduces incidence of allergies
Economical - no waste
Antibodies - greater immunity to infections
Stool inoffensive - never constipated
Temperature always correct and constant
Fresh milk - never goes sour in the breast
Emotionally bonding
Easy once established
Digested easily within two to three hours
Immediately available
Nutritionally balanced
Gastroenteritis greatly reduced

From a publicity leaflet by the TIBS support group, Trinidad.

Weaning a Critical Time for Diarrhoea Transmission

Infants are at greatest risk of diarrhoea when foods other than breastmilk are first given. This is because during weaning infants are being exposed to food-borne germs for the first time and they are losing the protection of breastmilk which has anti-infective properties.

High levels of contamination are often found in animal milks and traditional weaning foods, especially cereal gruels. Escherichia coli, which causes at least 25 per cent of all diarrhoea in developing countries, is commonly found in weaning food.

Feeding bottles and rubber teats, which are particularly difficult to clean, are often breeding grounds for germs.

The need for infants older than 6 months to receive more than just breastmilk in order to grow well, balanced against the risk that this will result in diarrhoea, has been called 'the weaning dilemma'.

It is important for health workers to work with local communities to identify and encourage safe weaning practices and to improve infants' nutrition to increase their resistance to infections such as diarrhoea.

Improved weaning practices

Complementary foods should normally be started when a child is 6 months old. These may be started any time after 6 months of age, however, if the child is ot growing satisfactorily. Good weaning practices involve selecting nutritious foods and sing hygienic practices when preparing them.

The choice of complementary foods will depend on local patterns of diet and agriculture, as well as on existing beliefs and practices. In addition to breastmilk (or animal milk), soft mashed foods (e.g. cereals) should be given, to which some vegetable oil (510 ml/serving) has been added.

Other foods, such as well cooked pulses and vegetables, should be given as the diet is expanded. When possible, eggs, meat, fish and fruit should be also given.