Health Watch

World Breastfeeding Week from August 1 to 7:

No replacement for breast milk

Ruwanthi ABEYAKOON

With great joy I watch the fish like motion of the toothless mouth suckling the milk and there flowed to my little son my deepest thoughts, dreams and most of all the endless love I have for him.

The greatest joy in a woman’s life is to feel life stir under her heart for ten months, take the little one to nurse and watch him grow to manhood. Motherhood and breastfeeding are two words that goes hand in hand. Breastfeeding is the best way to provide newborns with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.

To highlight the importance of breastfeeding, ‘World Breastfeeding Week’ is celebrated every year from August 1 to 7 in more than 170 countries. It commemorates the Innocent Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding. At present Lankan mothers are also encouraged to breastfeed the newborns for a complete period of six months.

Dr. Dhammica Rowel, Consultant Community Physician, National Programme Manager (Intranatal and Newborn Care), Family Health Bureau expressed her views on breastfeeding.

“Sri Lanka is a country where breastfeeding is culturally acceptable. An aggressive programme to encourage breastfeeding was initiated in the early 90s when world over pediatricians identified the ill effects of formula feeding. This programme was well supported by the governments.

According to the statistics of the Demographic and Health Survey only 18 per cent babies were exclusively breast fed up to four months in the year 1993. By 2007 this figure rose up to 86 per cent which shows a good improvement,” she said.

“National Nutrition Policy of 2010 specifies initiating breast feeding within the first hour of birth, exclusive breast feeding for complete six months and continue breast feeding up to two years or beyond with adequate complementary feeding that provide sufficient energy, protein and micro nutrients to meer a growing child’s nutritional needs,” she added.

Benefits of breastfeeding

Dr. Rowel says colostrum, the yellowish, sticky breast milk produced on the first two to three days is the perfect food for the newborn, and feeding should be initiated within the first hour after birth. “Colostrum in addition to providing nutrients protects the baby from infections, which is extremely important in the newborn period.

Babies are extremely alert just after they are born and the first hour in the life of a baby is called the ‘first golden hour of learning’. The babies who are initiated with breast feeding within the first hour is found to breast feed for a longer time successfully which is beneficial for the overall development of the child.”

“In addition to providing colostrums, initiation breastfeeding in the first hour provides many other advantages for the newborn. The very first encounter with the mother enables to strengthen the bond between the mother and the child that will last a life time.

This initial skin to skin contact prevents the newborn baby from getting cold (hypothermia) which is extremely important at this time in the life of a newborn. Also the skin to skin contact enables the organisms on the mother’s skin to first colonize with the baby’s skin protecting him/her from other infections in the environment,” she said. According to her exclusive breast feeding up to six months confers many short-term and long-term benefits on both child and mother.

“Mother’s milk is tailor made for her own baby and it is a live fluid which has living cells that protect the newborn from infections. Breast milk contains all the nutrients that an infant needs in the first six months of life, including fat, carbohydrates, proteins, vitamins, minerals and water. Breast milk also contains growth factors that supports the maturation of the gut of the newborn, bioactive factors that augment the infant’s immature immune system, providing protection against infection, and other factors that help digestion and absorption of nutrients. Breast milk is easily digested and efficiently used,” she said.

“Diarrhoea and pneumonia are more common and more severe in children who are artificially fed than those who are breast fed. Risk of diarrhea is 17 times higher and risk of pneumonia is three times higher in artificially fed babies than in breast fed babies.

Artificially-fed children have an increased risk of asthma and allergies. Not only during infancy and childhood breastfeeding reduces the risk of obesity, hypercholesterolemia, ceoliac disease and diabetes later in life,” she added.

Regarding intelligence, Dr. Rowel said cognitive function is higher among children who were breastfed compared with those who were formula fed.

“Exclusively breastfed babies have an IQ level ten times higher than formula fed babies. Breast milk is the best source of DHA (Decosahexaenoic Acid, and omega 3 fatty acid) which is important at the initial period for the brain development.

DHA is available in fish oil and research has shown that all the indigenous varieties of fish in Sri Lankan seas have ample DHA and are very good sources of DHA.

Increased duration of breastfeeding has been associated with greater intelligence in late childhood and adulthood which may affect the individual’s ability to contribute positively to the betterment of society,” she explained.

She added that breast feeding is a process and the care, tenderness, warmth and the love experienced by the child in breast feeding ensure an overall development of the baby.

Breastfeeding also has both short and long-term benefits for the mother as well.

“The extra fat that she gained during the pregnancy period can be shed and she can get back to her shape. There is increasing evidence that the risk of diabetes, breast and ovarian cancer is less among women who breastfed. Research has shown that longer a mother breast feeds, her risk of breast cancer become lesser,” Dr. Rowel said.

Working mothers

Dr. Rowel said in developed countries, they have identified that there is a business case to promote breastfeeding. “The business organizations have found that breast feeding mothers are more productive workers.

They are happy because their babies are healthy and they are in communication with their babies even while at work as they are expressing breast milk during working hours. On the other hand if the management discourages breast feeding the company will eventually lose experienced and trained persons from the work force as some of them might opt to resign from work in order to ensure that her baby is breastfed,” she said. Thus to retain them they encourage breast feeding.

It is an important social responsibility of business organizations to support breast feeding mothers as breastfeeding according to evidence based guidelines invariable produces a a healthy future generation.

Therefore it is a very important step forward that can be adopted by all the workplaces in Sri Lanka too, where women are employed to have a separate small corner (room with a comfortable chair, wash basin and if possible a refrigerator) to express breast milk while at work,” she said. “It is important to train a mother to express milk and to cup feed. If a situation arises where the mother has to leave a child this comes handy. Every working mother should have a plan of feeding her baby. Expressed breast milk can be kept for six hours in the normal environment. If it is refrigerated in the lower compartment it can be kept for 24 hours and in the freezer compartment even for a month.

The milk should be expressed in to a wide mouthed container and can be kept covered. To feed expressed breast mother can use a small wide mouthed cup or a spoon. Feeding bottles should never be used to feed infants. If babies are fed with bottles they can get confused with the nipple and teat and tend refuse feeding from the breast. Also feeding from the bottles make babies more prone to get infections,” she added. Dr. Rowel said working mothers should express milk every three hours while at work. “It will assist in the continuation and sustainability of the milk production.

Working mothers should continue night feeds that is vital for stimulation of milk producing hormones that again help continuation of breastfeeding. She should receive a lot a support and encouragement from the extended family.

Every working mother should develop a plan to continue breastfeeding, about two weeks prior to the date she intends to return to work. This can be done in consultation with her midwife and the family,” she said.

Drinking alcohol, even in moderation, ‘a dementia risk’

Drinking even “moderate” amounts of alcohol increases dementia risk, a US research suggests

The findings, presented at an international conference, challenge the notion that some alcohol could be good for ageing brains.People who stick to recommended alcohol limits are still at risk, as well as bingers and heavy drinkers, according to the work.

The study tracked the health over 20 years of 1,300 women in their mid-60s. The risk, ranging from mild cognitive impairment to full blown dementia, was higher among those who reported drinking more alcohol. Many people will drink to relax and it's important to keep an eye on the amount of alcohol we consume”

Women who switched from abstinence to drinking over the course of the study also increased their risk.

Those who drank alcohol “in moderation”, meaning seven to 14 alcoholic drinks a week, were also more likely to develop problems with memory and brain functioning that can be a warning sign of future dementia. The lower end of this range falls within the UK's recommended limit for women, but since alcohol measures in the US are larger than in the UK, 14 drinks a week would exceed this UK weekly cut off.

And since the study only looked at women, it is not possible to say if the same link will apply in elderly men. Researcher Tina Hoang, of the Veterans Health Research Institute in San Francisco, said: “In this group of older women, moderate alcohol consumption was not protective.

One unit of alcohol is 8g or about half a pint of lager, a small glass (125ml) of wine or a 25ml of spirits. “Clinicians should carefully assess their older patients for both how much they drink and any changes in patterns of alcohol use.”

She told the Alzheimer's Association International Conference that it might be that brains become more vulnerable to the effects of alcohol as we age. Some UK experts have recommended alcohol limits should be even tighter for older people for this reason. Alternatively, the researchers say the link could be caused by factors that drive people to drink - stress or bereavement, for example. At the same meeting, another group of US researchers presented more work showing the potential harms of binge drinking.

Among the 5,075 men and women they studied, those who reported heavy bouts of drinking - at least one episode per month - were more likely to experience dementia-like problems. Fortnightly binges doubled the risk.

Drinking alcohol can cause your blood pressure and blood cholesterol to rise which, in turn, can damage the blood vessels supplying the brain, causing problems like vascular dementia. Men are advised to drink no more than three to four units of alcohol a day, and women no more than two to three units a day. A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) of spirits.

Dr Marie Janson, of Alzheimer's Research UK , said: “In a country with major concerns over binge drinking, these new findings should be taken seriously by people of all ages.

“These researchers found that in older people, even moderate drinking may have a harmful effect, in contrast to some previous research suggesting that moderate drinking may bring benefits. “Such differing findings underline the need for more in-depth studies to tease out how different drinking patterns affect cognition.

She said that the best advice was to keep alcohol consumption light throughout life to reap some benefits and protect against the risks of over-indulging.

-BBC