HOW TO RAISE A HEALTHY CHILD
( By Edited by A.P. Dewan )

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Breast Feeding

Breastfeeding is a fundamental requirement. It is not merely a matter of choice. Nature brings milk to the breasts of the mother simultaneously with the birth of the child. Why?

During the first 72 hours after delivery, the breasts produce a thin yellow fluid called colostrum containing antibodies that protect the baby against a range of intestinal and respiratory infection when his own immune system is very weak. Why?

Quantity of milk produced depends to a great extent on the sucking action of the baby at the breasts which sends messages to the hypothalamus which in turn stimulates the pituitary gland in the brain to release two hormones : Prolactin which is responsible for the manufacture of milk in the milk glands, and oxytocin, which causes the milk to be passed from the glands to the reservoir behind the areola. Intensive sucking means more release of prolactin hormone and manufacture of milk in the milk glands and viceversa. Thus the supply of milk is, to a certain extent, dependent on the intensity of the demands of the baby. Why is such a variable capacity designed for the milk machine of the mother?

It is abundantly clear that this food manufactured by this maternal system is meant for the feeding of the infant, for his nutrition protection. Anybody who, for what-so-ever reasons, deprives the child of this breast feeding, commits an offence against the laws of nature and must be punished in one way or the other. If you deprive a person of something manufactured for his exclusive use and which is so important for his protection and for his growth, and especially if that person is your own child, can you ever forgive yourself for such an act of neglect and indifference?

Composition of Human Milk

Breast milk is individualised for each child. Raw materials for the production of this milk are selected from the blood stream of the mother, according to the needs of the child. Breast milk changes in composition from day to day. It is custom designed for your own child. While the colour of ordinary milk is white, the colour human milk in the beginning of feeding is bluish because of low fat content but becomes creamy towards the end of feeding due to fat content going up. Human milk contains more of vitamins A and E, and also of vitamin C if the mother is eating well. Human milk contains twice as much iron as the other milk and it is better absorbed. All iron requirements are met for the first six months from first breast feeding. Zinc which is extremely important for growth is available more in breast milk. Outside milk contains more of calcium, phosphorus and sulphur but most of these minor minerals are excreted and so is extra protein. Human milk contains more sugar and has higher cholesterol level but that helps fight high levels of cholesterol in later life. Human fat globules are smaller and absorbed easily. Fat of outside milk is high in saturated fatty acids. Human milk contains enzyme Lipase which helps digestion. It also has growth modulator amino acid. Taurine which is very important for development of brain and the nervous system. It is because of the superiority of the human milk that a few banks/stores of human milk are reported to have come up in USA inspite of its low shelf life.

Advantage of Breast-feeding

Breast feeding benefits the nursing mother in many ways. It is good for your figure. Fat stores developed during pregnancy are laid down specifically for lactation. In the absence of breast feeding, that fat will look unseemly in various parts of your body. With breast feeding you burn almost 1000 calories each day. With a little care and management your beauty can blossom forth. Nursing does not ruin the breast. Instead you become a fuller blossomed woman and with proper care of the breasts light massage etc. during breast feeding, you may yourself be surprised to see how shapely your breast look after a year of delivery. It is an established fact that breast feeding, causes the uterus to shrink more quickly to pre pre-gnancy size. It also decreases the post delivery bleeding. There is no menstruation generally for the entire period of active breast feeding. It is good for health because you get many spells of relaxation every day when you are feeding and making love with your child. Hormone prolactin also enhances this feeling of relaxation. Breast feeding is nature’s contraceptive. Hormonal balance in your body will prevent ovulation. But, please note that breastfeeding, on its own, is not a very reliable method of family planning.

Breast feeding is convenient for the nursing mother, no bottle have breasts with are not limited by the size of the breasts. You can breast-feed a premature baby. You can breast-feed even if you have started mensurating and even if unluckily you have become pregnant again, in which case quantity of breastfeeding will have to be reduced. In case of breastfeeding your child continues to smell good. Even his bowel and milk spit do not have the strong odour of a bottle-fed.

After a couple of weeks, breast feeding becomes pleasurable for the mother. Many nursing mothers say that the pleasure sensation they feel in their breasts and in their genital region while they are nursing are very similar to the sensations they experience during sexual excitement.

Breast milk alone is the best feed for a baby upto 4-6 months of age. Breast milk is nutritionally and chemically balanced. It is at the right temperature. It is sterile and contains immune substances. And it is available to the baby always. It is always ready to drink, sanitary and uncontaminated. Its protein is nutritious and digestable than cow’s milk protein. Mother’s milk has higher level of zinc which is important for growth and for a strong immune system of the child. It prevents constipation and lowers the incidence of food allergies. Breast-fed infants use their calories more economically.

Dr.A.S. Goldman of the University of Texas Branch at Galveston says, "it is already widely accepted that human milk is rich in factors that protect directly against infection, but we found evidence that it contains at least one factor that activates the baby'’ own immune system"" Mother'’ milk transmits antibodies and protective substances Scientists have found that 75% of the cells in breast milk are macrophages that kill bacteria, fungi and virus. Those cells also help to stop the growth of cancer cells. Scientists have also recently discovered that a solution containing 5% content of human milk killed half a culture of parasites in a test tube within 30 minutes. Cow’s or goat’s milk was unable to produce a similar result.

Breast feeding causes less diarrhoea, no respiratory illness and less of other infections. It promotes better digestion by forming softer curds in his in his stomach. There are no allergic reactions, no eczema, asthama or running nose. Suckling at the breasts is good for baby’s teeth and jaw development as these muscles are exercised in suckling.

The main case against breast feeding is that it is a solitary pursuit and becomes boring for the mother. Of course this activity cannot be shared by others. But imagine how much opportunity it provides for forming bonds between the mother and the child and thus laying a foundation for a happy family relationship. It does require an effort and a commitment. But if such a commitment is not there, why go in for a child at all. Another objection raised is that there is no easy way of knowing as to how much milk has been consumed by the child in case of breastfeeding. The wet diaper, regular bowel movement, sleep following nursing, the bright eyes, alert look, the glow and the smile on the face of the child all show his contentment. Mother also feels the flow and a periodic weight gain will by itself show how much is the intake. The only problem faced in case of breast feeding is that the medicines taken by the mother get transferred to the milk. But only a few commonly used drugs are contra indicated for the child. Most vitamin supplements are contra indicated for the child. Most vitamin supplements are safe. The mother as also her physician have to be careful in this behalf.

Regulating Milk Supply

Milk supply for the baby is influenced by the parents management. Worry, tension and fatigue rob you of the milk output. Rest and relaxation add to it. The more often you nurse your baby and the more vigorously he nurses, the more milk you are likely to have. The release and working of the two hormones-prolactin and oxytocin, manufacturing and supply of milk due to the sucking action of the baby has already been explained . Frequent sucking is needed to produce enough breast milk for the baby’s needs. If the mother is a reluctant feeder, the production of milk in her system is bound to go down. Incases where the breast milk is supplemented with cow or goat milk, powder solutions or other breast milk production. This reduced production may not be sufficient to meet the needs of the baby and may have to be further supplemented. Once supplementation with bottled milk starts, it means entry into the vicious circle of ever reducing milk production. The use of a bottle to give other drinks to the baby can cause some to stop breastfeeding completely. The sucking action of bottle feeding is different from that of sucking the breasts and the baby will usually prefer the bottle because less sucking is required. After 4 weeks, it may not only effect the milk production but may ultimately even ease the weening process. If contraceptive pills are used during lactation, the hormones of the pill may inhibit milk production.

Expressing milk manually for five minutes gives extra stimulation and results in greater production. In the first few days there will generally be drought of milk. Such a situation is controlled by expressing manually for stimulating production. Expressing manually may also be necessary in case of working women. The milk thus expressed could be stored for upto eight hours and fed to the child.

Food taken by a nursing mother directly effects milk production. Following foods may be tried for increasing her milk flow:



  1. Fennugreek seeds (H.Methi) : A gruel of these seeds will help considerably.
  2. Alfalfa : It could be taken as sprouts, tea made from seeds or juice of fresh alfalfa leaves. This juice could be taken with carrot juice or some other organic drink.
  3. Musk melon : With its combination of calcium, potassium and sodium, it stimulates milk production in nursing mothers.
  4. Raw papaya is eaten as a curry by women to stimulate secretion of breast milk.
  5. Whole potatoes : When baked or roasted in their skins.
  6. Black gram dhal (H.Urad dhal) as also parsley and amaranth increase production of breast milk. Dhal should generally be taken in the mornings.
  7. The leaves or seeds of fennel (H. Kala Zeera) boiled in barley water and drunk are good for increasing the breast milk.
  8. An admixture made with aniseed (H. Sonf) taken on empty stomach increases both the quality and the quantity of breast milk.
  9. Milk of peanuts extracted by wet crushing of these nuts which have been soaked in water for 24 hours. This peanut milk should be diluted before being given to the mother.
  10. Diluted grass juice. Nothing else should be consumed for at least two hours thereafter to help assimilation.
  11. Garlic, tamarind and cotton seeds also help in increasing milk supply.
  12. Soups and red gram also stimulate milk production.

Do not forget that adequate rest, less work, well-balanced diet, iron and vitamin supplements, lots of fluid and manually expressing the milk if the baby does not empty the breasts, are the basic formulae for getting adequate milk supply.

Feeding Postures

A good nursing position is such that you can hold the position for some time without feeling cramped or stiff. Bring the baby to the breast, not the breast to the baby. Baby’s body should be face to face with yours. His mouth should directly face the nipple and he should be close enough to take all of the areola or much of into his mouth.

In the beginning and for night feedings it would be more restful to lie down to nurse. Lie on your side with a pillow under your head and one or two behind your back. Use folded cloth or towel under the baby’s head as he lies facing you with his mouth at breast level. Your bottom arm can be up and out of the way or under the baby’s head. Nurse the baby first on the bottom breast then tuck that breast under your bottom arm and lean over the baby and nurse with the top breast. Switch sides next time.

For sitting position, sit straight up in bed or in a comfortable chair. Position the baby so that his head, chest, genitals and knees all face you. His buttocks should be in one hand of yours and his head should be in the bend of that elbow. Slip your other hand under your breast with all the four fingers supporting the breast without any of the fingers being on the areola. Gently touch the lower lip of the baby with the nipple to get his mouth wide open. Quickly pull his body in so that the mouth fixes on the areola. The nipple should be deep in baby’s throat. This way there will be no movement of the nipple when the baby sucks.

If there is pain, insert your finger in the side of his mouth to break the suction and reposition the baby. Do not pull him off the breast. His mouth should cover the nipple fully. If he drifts, wake him, burp him and switch sides.

Only two postures have been described above by way of illustration. There could be many more in keeping with the basic requirements given above. The ultimate position will have to be determined only by you and your baby, one which is convenient to both of you. Positioning of the baby and the breast is of great importance. A faulty sucking position can cause sore or cracked nipples, inadequate flow of milk or even refusal of the baby to feed. If the positioning of the mother and the child is good, the baby’s whole body will be turned towards the mother. The sucks will be long and deep. The baby will be relaxed and happy and the nipples will not pain. Be gentle to the baby. Do not hold the head to direct the mouth to the breast. Do not squeeze across the cheeks to get the mouth open.

Frequency

It is strongly recommended that the breast feeding should start within the first hour after delivery. Breast feeding should be continued well into the second year of the life of the child. Breast milk provides energy and protein to the baby and protects him against disease. Such a protection is needed more in the second year when he learns to walk and play and gets ill frequently. Longer period of breastfeeding will lay a solid foundation for a healthy life in years to come. It is a sin to terminate breastfeeding earlier as a matter of choice. Decision to terminate breastfeeding should be a joint decision of both the mother and the child. It should be continued so long as the child wants it and asks for it. If he wants to terminate it earlier than nine months, you and your husband should jointly look into the possible causes of such a termination and try to remedy the situation. Do not be discouraged; Do not quit easily. Try and continue trying. If, on the other hand, the mother asks for it and cannot be convinced to continue, it seems nothing can be done. Milk will not come to the breasts of such a mother in adequate quantity. First thing is convince such an unwilling mother. Then there are cases where the child does not agree to the termination of breastfeeding and must have one or two feeds even after 2 years of age. Advice is to continue with it so long as the mother can manage it. Longer the better. In Indian villages many mothers breastfeed their children for over two years. That is what the tradition has taught them.

Mother produces the most milk in the morning when she is rested. First two feeds should consequently finish by the mid morning. Please remember that breast fed babies, on an average, feed more often because breastmilk is digested more easily and quickly. In the first two weeks feeding may be needed 10-12 times a day. The feeding should not be by the hour. It should be on demand. Do not draw up a programme as to at which hours the feed will be given. Baby feeds to go to sleep again and wakes up to take the feed. On the first day nurse the baby for 5 minutes on each breast at a time till the baby is satisfied. On the second day feed him for 10 minutes at a time on each breast and on subsequent days for 10 to 15 minutes at a time on each breast and feeding must be done at both the breasts on every occasion. After sucking at one breast, burp him, diaper him, if necessary, and then put him to the other breast and then let him drift off. General observations indicate that from 10-12 feeds per day in the first two weeks, he may demand only 5-6 feeds at the end of 8 weeks and 4-5 feeds per day thereafter. The frequency of breastfeeding will be reduced considerably if he is bottle-fed in between.

Milk ducts can clog as a result of tight clothes, fatigue, prolonged periods without nursing or even because of body curves of the mother. It may even result in infection. In such an eventuality besides applying warmth and massaging, allow the baby to nurse on that side more frequently. Baby's suckling will help clear out the duct faster than everthing else. If you develop breast infection on any other count also, do not stop feeding. Instead nurse more frequently. You thus give anti-bodies to the child.

If cow’s milk or any other formula is used in the first few days, chances of continuing breast feeding and its frequency are reduced.

Breast Care

A well fitting brassiere is the first requirement for the last few weeks of pregnancy and for the entire period of breast feeding. A good nursing bra should be of pure cotton, with wide opening for nursing, with comfortable straps and not tight across the chest. It should be easy to open and close the bra with one hand. It would be better to have a bra that lets you uncover one breast at a time.

The breasts and nipples need regular and systematic attention three months prior to delivery. The annointing and massage of the nipples prevents their cracking that so often interferes with successful breast feeding. During this predelivery period do not use soap on the nipples. The glands around the nipples will be secreting substances to keep them Clean. Soap will dry them out. Breast massage will prevent clogging of the milk ducts. Nearer child-birth manually express colostrum a couple of times to open the milk ducts and prevent engorgement. The nipples should be toughened. For this rub your nipples briskly but gently with a towel after daily bath. After rubbing take the nipple between your thumb and forefinger and pull it out firmly. Twist or role the nipple between your fingers for a minute or the privacy of your house with your breasts uncovered to expose your nipples to the air. Occasionally allow your nipples to rub against your clothing by going without a bra. Sometimes encourage your husband to stimulate your breasts both manually and orally, as part of love making and enjoy the same. In case of inverted nipples, pre-natal preparation is very necessary. These can often be drawn out during pregnancy. These preparations will greatly help in healthy nursing. If you leak milk, press the nipple into the chest using cotton handkerchief to press it in.

Within 2 to 4 days of the child birth, because of the increased blood supply to the breasts and because of the pressure of the newly produced milk, the breast tissues get swollen. In such cases give frequent feeding. Apply mild moist heat to the breasts for about 20 minutes before feeding. In mid-feeding have a mild massage of the breasts towards the nipples to get milk flowing.

In case of sore or hard breasts or where the breasts get swollen or caked, see that the child does not suck one breast for more than 12 minutes because ordinarily the child should be able to empty one breast in about 7 minutes. Over-sucking will make it more sore. Nurse on the less sore side first. After feeding, prepare pancakes of wheat flour, baking soda and sour milk and supply hot pancakes to cover the affected part fully. Change them and reheat them to complete 15 minutes of fomentation. Alternatively, bake large potatoes, crush them and put the soft potato pulp in a woolen cloth and apply to the breasts as hot as can be tolerated. Continue for 15-20 minutes. Supplement of bone meal and dolomite tables consisting of calcium and magnesium may also relieve painful breasts.

For relieving engorgement, before starting feeding, express a little milk manually. This will soften the breast. Massage the breast once or twice from the outer edge towards the nipple. Apply hot or cold packs before starting feeding.

For treating sore nipples, ensure that during feeding mouth of the baby Covers minimum portion of the areola and some milk is expressed manually before breast feeding. Nurse more frequently. In such cases less sore side may be taken up first. Limit sucking to five minutes on the sore side. To ease pain, apply ice to your nipple just before a feeding. Use vitamin E, pierce a capsule, squeeze out a drop and rub in into the nipple after finishing nursing. Do not wipe away any milk left on your breast after a nursing. Let it dry there. That milk at the end of the feed is high in lubricants and contains an antibiotic. Do not use soap, alcohol or tincture of benzons on your nipple. After bath expose your nipples to the light of a 60 watt bulb for 10-15 minutes. The most important thing in this behalf is to keep the nipples dry by exposing them to open air, Change nursing position so as to change the pressure of the child’s mouth on different sides of the nipple.

For treating a clogged duct, feed more often and longer so that the baby empties the breast. Change position from lying to sitting. Express manually the affected breast after each feeding. Offer the sore breast first. Apply moist heat. Do not sleep on your stomach as that will put pressure on your breasts. Continue to nurse. Do not stop.

For cracked and sore nipples, after nursing, apply molasses on the nipple. This treatment will never fail you. The other cure is to apply gelly made with the seed and white substance at the centre of quince (H.Behi). Soak the seeds in a little hot water, Strain off seeds before it becomes too thick. Apply that gelly. You may avoid cracks if you apply a little olive or peanut oil as often as you remember and certainly after feeding.

Miscellaneous

American Folk Medicine by Clarence Meyer says "Sage (herbal) tea given in cold infusion will, within a few days, cause the milk to leave the breasts". This is, then, the way to stop producing milk, when so considered necessary and urgently. Otherwise, if the breastfeeding is stopped, your body will stop creating those hormones and milk production will taper off. For this reason, if you need to stop breastfeeding temporarily, you should keep expressing milk manually so that the production continues in the body. Working women should expel some milk at place of work when they cannot hold it any more. On reaching home, expel little more milk, wash the breasts and then feed the baby.

If your breasts sag or are small, develop the pectoral muscles. That will make the breasts seem larger and firmer. To accomplish this, Maggie’s "Woman’s Book", prescribes the following exercise:

"Lie on your bed. Rest the upper arm on the bed and bend the elbow so that the hand is straight in the air. Put up your elbow and swing your arms in and down towards your thighs, circle them back up. Start making small circles, working slowly towards your thighs, and back up, then circle in the other direction. Repeat this exercise in each direction a few times. Now find the position where you feel the muscle is working most and work there. To trim down or to keep in shape do just a few circles each day with light weights in hands" besides firming the breasts, this exercise may increase milk cells as well.

Pay close attention to your nutritional needs. You expend about 1000 calories a day in breast-feeding during the first five months of nursing. These calories have to be met mainly by increasing the protein foods by 50% and dairy foods by 100%, fat intake remaining the same. Take lots of fruits and vegetables as also whole-wheat bread besides foods which increase foods which increase the milk production. Special attention must be paid to the intake of adequate quantities of calcium and vitamin D. Non-fat dry milk and, for non-vegetarian mothers, white of egg are goof foods for the period of nursing. Fluids, that is, water, milk, soups and juices should be taken in abundance, Great care should be taken to see that you do not put on extra weight. Also please see that you peel or thoroughly wash vegetables to get rid of pesticide residues and avoid fat rich dairy products. Avoid caffeine. Avoid cabbage family vegetables because these produce gas. Please remember that it takes about 4 to 6 hours before the food eaten by the mother effects the milk of the breasts. Avoid dieting. If you are not already much overweight, do not lose more than one kilogram a month while you are nursing. Moderate exercise is necessary during this period. It could be generally taken after nursing. You could go for walks, and your child, on many occasions, could, in a pram, be your exercise "buddy".

There is no single optional time for weaning. Wean when your baby loses interest, after a minimum period of six months at least. Weaning should be a mother-child decision when there remain no nutritional or emotional reasons to continue brestfeeding. Then do not offer breast, nor refuse it. If mother wants to withdraw, then bottle milk is better than nursing at a grudging breast. For easing the weaning process, make nursing sessions shorter. Use distractions before and while nursing. Give attractive and favourite other foods before starting breast feeding. Invite his playmates just before nursing hour. Give him lot of affection during those activities. In the process of reducing nursing, first discontinue those sessions which are inconvenient. Continue talking to the child about a deadline for weaning because he was now a "big boy". Give examples of others. Do not use traumatic techniques. Nurse occasionally when the child implores. These suggestions for weaning have been given when weaning becomes necessary for medical reasons or because of certain conditions of the mother. Otherwise continue nursing, especially when the child wants it. His emotional sucking and proper food for the mother are likely to continue enough milk for him.

More important than all the benefits of breast feeding given above are the physical and emotional bonds of the most intimate nature created between the mother and the child by that skin to skin and eye to eye contacts between the two. It provides the most gratifying experience for both of them. Nursing does not provide food alone. It also provides the warmth, the love and the motherly unspoken reassurances that he can always fall back upon her for comfort, when-ever needed. It makes him the child of the mother for whom she can sacrifice anything. Mothers who have not nursed for a full term do not know what they have missed!!!

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