Exclusive Breastfeeding during the first six months of life is crucial in combating several diseases, including pneumonia, by supplying the infant with all the nutrients, as well as sufficient immunoglobulin antibodies, which provide immunity to the respiratory tract, and contribute significantly to the development of a healthy immune system. Infants who are not breast fed at all are 5 times more likely to die from pneumonia than those who are exclusively breast fed. One must not forget that pneumonia is an infection of the lungs, filling them with pus and fluid, limiting oxygen intake and making it hard to breathe. It occurs due to bacterial infections, (although viruses or fungi can also be the cause), which attack when the child’s still-developing defense system is weakened by malnutrition, air pollution, co infections with HIV/AIDS, tuberculosis, influenza and measles, and low birth weight.
However, currently only 38% children worldwide are exclusively breast fed. Barriers to exclusive breast feeding include time constraints, cultural norms, multiple births, ready access to formula milk and lack of knowledge. Dr Dinesh Chandra Pandey, a Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow, rues that, “Nowadays we have what is called cocktail feeding which is more prevalent in mothers, especially in working mothers. So their children depend on top feed or fortified milk.”
Dr Ajay Misra, Managing Director of the 36 bedded Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow, had treated 30 children with severe pneumonia during the past 6 months. When I visited his hospital in September 2011, five cases of neonatal pneumonia (less than 10 days old) were admitted in the hospital, along with a few older children.
Dr Amita Pandey, Associate Professor of Obstetrics and Gynaecology at the Chhatrapati Shahuji Maharaj Medical University (erstwhile King George’s Medical College), which is a leading government hospital of Lucknow, also confirms the high prevalence of early childhood pneumonia cases she has to deal with. She says, “We as gynaecologists, often come across early neonatal pneumonias within 48 hours to 7 days of birth. 50% of all deaths due to childhood pneumonia occur in neonatal cases. Studies have shown that 30% to 40% of still born babies, and 50% to 60% of those who died within 1 or 2 days, had evidence of pneumonia, as revealed by autopsy.”
Elaborating on the merits of breast feeding, Dr Amita Pandey says, “I work in a government hospital and the only feeding modality that is advocated and patronized in our setup is exclusive breast feeding (no water, no sugar, no gripe water, no honey, no coconut water) during the first 6 months of life. We let the mother start feeding the baby as early as within 10 minutes of delivery. We put the baby, cord and all, on the mother’s abdomen, and it crawls up and starts suckling. This early suckling also helps in the delivery of the placenta and the membrane.”
Dr Ajay Misra feels that, “Though mothers are aware of the benefits of exclusive breast feeding, they are very conscious about their beauty and physical appearance and hence do not want to breast feed. In villages, mothers prefer to feed the infants on cow milk, as they have many children.”
According to Dr Amita Pandey, “Poor mothers adhere more strictly to breast feeding than those from the higher socio economic status. Girls from well off families generally have problems in initiating and maintaining breast feeding. Many are working mothers who have to leave their baby home for long hours after a few weeks of delivery. So they either stop breast feeding the child early and/or ensure that the child has at least one top feed. They feel that if the child is not initiated into top feed from the beginning, it will not accept it later and thus create problems for them.”
A reason commonly cited by new mothers for not breast feeding is that they are not able to produce any (or enough) milk in the first few days, forcing them to put the baby on top feed. But Dr Amita Pandey strongly contends that whatever colostrums the mother produces during the first few days, are enough nutrition for the baby. A full term baby has enough glycogen stored in her to help her sustain for the initial two days. Moreover, if the baby is put to breast, the mother is bound to lactate eventually. It is like a cyclic process—put the baby to breast, there is a cyclic release of hormones, and the mother’s milk production increases. The more is the baby put to breast, the more would be the milk production.
Ironically, Anuradha, mother of a one month old baby (delivered through a caesarean section in a private nursing home) told that as she did not lactate immediately after the delivery, the doctor allowed her to feed her baby on formula milk through an unsterilized cup and spoon for the first two days. Later she switched on to breast feeding the child. Similarly, another young mother Beena said that she is breastfeeding her 12 days’ old infant daughter, but has given her water too, with some medicine for diarrhoea. She was unaware of the harms of letting the baby drink water along with mother’s milk.
So there should be more awareness programmes at the community and hospital levels for young girls to understand the importance of exclusive breast feeding. Doctors too need to inform them about the health benefits of breast feed for the child. The World Health Organization recommends exclusive breastfeeding as the sole source of food until an infant is six months of age, and thence a combination of it with complementary foods till two years of age. Expectant mothers need to remember that their milk is one of the most important tools in the armoury of the baby to prevent pneumonia and several other diseases, and that contrary to popular myths, the baby needs mother’s milk, and nothing but mother’s milk during the first six months of life.
Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: firstname.lastname@example.org, website: http://www.citizen-news.org/)