BREASTFEEDI

NG
BASI
CS
 Br east feedingist henat ur alprocessoff eedi nghumanmi lkdi rectlyfrom the
breast.
 Br eastmi lkisthepr eferr ednut rit
ionals our ceandt henor malandphys iol
ogic
wayt of eedallnewbor nsandi nfant s.
 Br eastmi lkcont ainsover200ac ti
vec omponent swhi chpr ovi denut riti
on,f i
ght
pathogens ,promot eheal thygutmi c robi ome,andai dinmat ur i
tyofi mmune
syst
em.
 TheAmer i
canAc ademyofPedi atri
c s(AAP) ,theAmer i
canAc ademyofFami l
y
Phys i
c ians(AAFP) ,Amer icanCongr essofObs tetrici
ansandGynec ol
ogists(ACOG),
Wor ldHeal thOr gani zation,UgandaMi nistr yofHeal t
handot hermedi cal
organi zationsr ecommendexc l
us i
vebr eas tfeedi ngf or6mont hs,wi t
h
continuat ionofbr eastfeedi ngfor≥1yearasdes iredbymot herandi nfant.
 Themec hanism ofmi l
kpr oduc ti
oni sbas edons ever alhormones :Prolacti
n
tri
gger smi l
kpr oduc tionandoxyt oc i
nr eleas esmi lkbas edons uppl yand
demand.Endoc rinec ont rolsystem t rigger smaki ngofc olostrum at5
mont hs ’gestati
on.
 Al veol imakemi lkinr es pons etohor monepr olac t
in.Suc ki
ngs timulates
secretionofpr olac t
in,whi chtrigger smi lkpr oduc ti
on.
 St i
mul ationofar eolac aus essecretionofoxyt ocin.Oxyt oc i
ni sr esponsiblefor
milkl et-downr eflexwhenmyoepi thel i
alc ellsc ont ractandmi l
ki sejectedinto
milkduc t
s.

DESCRI
PTI
ONOFMATERNALBENEFI
TSOFBREASTFEEDI
NG

Maternalbenef it
s( ascompar edwi thmot herswhodonotbr eastfeed)includet he
f
oll
owi ng:
– Rapi di nvolution/decreas edpos tpartum bl eeding(duet ooxyt ocinr el
eas e).
– As s ociationofdec reasedr iskofpos tpartum depr essi
onandi ncreased
bondi ng.
– As s ociatedpos tpartum wei ghtl oss.
– Dec reas edriskofbr eas tc ancerandas sociati
onofdec reasedr i
s kofpr e-and
postmenopaus alovar i
anc anc er,dec reasedr iskoftype2di abetes,hyper tension,
hyper l
ipidemia,r heumat oidar t
hr i
ti
s,andc ardiovasculardi sease.
– Dec reas edriskofpr emat ur i
tyduet oc hil
ds pac i
ng.
– I ncr easedbonedens i
ty.
– Conveni enceandec onomi csavings .
– As s ociationofl ongerc ont inuationi nwor k/schoolactivit
ies.

DESCRI
PTI
ONOFI
NFANTBENEFI
TSOFBREASTFEEDI
NG

I
nfantbenefi
ts(
ascomparedwit
hchi
ldrenwhoaref
ormul
a-f
ed)i
ncl
udethefol
lowi
ng:
– I dealf
ood:eas
ilydi
gest
ibl
e,nut
rientswel
labsor
bed,l
essc
onsti
pati
on.

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 – Lowerr atesofvi rt
uallyallinfec tionsvi amat ernalantibodypr otect
ion.
Fewerr espiratoryandGIi nfec tions .
Dec reas edi ncidenceofot it
ismedi a.
Decr eas edr i
skofbac t
erialmeni ngiti
s,pneumoni a,ands epsis
.
Decr eas edincidenc eofnec rot i
zi ngent erocoli
tis
.
Decr eas edr i
skofeari nfec t
ions .
– Decreas edi nc i
denc eofobes ityandt ype1and2di abetes.
– Decreas edi nc i
denc eofallergies ,c l
inicalast
hma,andat opicdermatiti
sin
chil
dhood.
– Decreas edr i
skofdevel opingc eliacdi seaseandi nflammat or
yboweldi seas
e.
– Decreas edr i
skofc hildhoodl eukemi a.
– Decreas edr i
skofs uddeni nfantdeat hs yndrome( SIDS)anddec reas
edmor tal
it
y.
– Enhanc edneur odevelopment alper formance.
– Increas edat tachmentbet weenmot herandbaby.
– Decreas edc hil
dabus e.
– Decreas est her iskofur i
nar ytr ac tinfecti
on.

OBSTACLESTOBREASTFEEDI NG.
Thesearethemodi
fiabl
eandnonmodi
fiabl
efact
orst
hatreducet
hef
requencyof
breast
feedi
ng

1. Heal t
hwor ker s(Doct ors)apat hyandmi sinformat ion.
2. Insuf f
ici
entpr enat aleducat iononbr eastfeeding.
3. Inappr opri
atei nterr
upt ionofbr east feeding.
4.Ear lyhospi taldischar ge.
5.Lackofr egularhomeheal thvi si t
s.
6.Mat ernalempl oyment .
7. Per suasi vecommer ci aladver tofi nfantf ormul a.
8.Endoc rine/ met abol i c:Cys ticf ibros is,diabet es ,galac t
osemi a,phenyl ketonuria,
andt hyr oiddys func tionmayc aus edel ayedl ac tat
ionordec reasedmi lk.
9.TheCDCr ec ommendsavoi di ngt heyel low feverors mal lpoxvac c
inei n
br eas t f
eedi ngmot her s.
10.Di ffer entbr eas tPat hol ogi ess uchasbr eas tc anc ers,Paget '
sdi seaseoft he
ni ppl e,sever ebr eas tabs ces sr educ ebr eas tf
eedi ng.
Cont rai
Maternal ndi cat
Illnessesi
othat
nst ob
arer eas tf eedi
obstacles ngaref ew ( Worl
(Contraindications) dHe
to althOrganincludes:
breastfeeding ization).
1)1.Ma
HIV ternalHI
infection. V( ini ndus triali zedwor ld).
2.HumanT- cel lleukemi avi rus( HTLV)i nfec t
ion.
3.Ac t iveunt r eatedt uber c ulos i s.
4.Ac t iveher pess i
mpl exvi rus( HSV)l esionsont hebr east*–Subs tancesofabus e
wi t houteval uat ion.
5.Revi ew medi cationst hatwi llpas sintohumanmi lk.
6.I nf ant swi thgal ac tos emi aormapl es yrupur inedi seases houl dnotbef edwi t
h
br eas tmi l
k.
7.I nf ant swi thphenyl ket onur iamaybef edbr eas tmi lkunderc l
oseobs ervat
ion.

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 8.Motherswhodevel opvar
icel
la5daysbefor
ethr
ough2daysaft
erdel
iver
y.
9.Mothersacutel
yinfect
edwithinfl
uenzaH1N1unti
laf
ebr
ile.
10.
Maternalhepati
ti
sisnotacontrai
ndic
ati
on.
11.
Express
edmi lkbeused

GENERALS UMMARY
 Breast
feedingi sveryimportantanditmus tbeini
ti
atedimmediatelyaf
terbi
rth,
ideal
lyplacingt heinf
antont hemother’
schestski
n-t
o-ski
ninfi
rsthour.
 Exclusi
velybr eastf
eedeveryhourint hefi
rstsi
xmont hsaft
erbirthbyemptying
andalternatingbot hbreas
ts.

MI
CRONUTRI
ENTSI
NPREGNANCY
Micronutri
entsaret
hef oodnutri
entst
hatar
edemandedbyt
hebodyi
nmi
nut
e
quantit
iesandtheyinc
ludevitaminsandminer
als
.

Tabl
e1:Someoft
hemi
cronut
rient
sandt
hei
rfunct
ionsduri
ngpregnancy.

Mi
conut
rient FoodSour
ces Func
tions

Vi
tami
nA Ripemangoes ,c antaloupe,  Retinol;Requi
redfornor
mal
apricots,
peac hes ,Pumpki n,c arrot
s, vi
sion,bonedevel
opment,cel
l
orange,f les
hed,s weetpot atoes,
di
ffer
entiat
ionandpr
oper
locall
yavai labl eVi t
ami nAr i
ch
gr
owt h.
vegetablesl eaves ,spinach,Nakat i
,
Gobbe,Mal akwang,Boo,Dar k  β-
carot
ene;mai
ntai
nsepi
thel
ial
greenl eafyveget ablesincluding
c
ell
sandhel
pst
ofi
ghti
nfec
tions
wildonesandl ocallyavailable
vit
ami nAr ichl eavess uchas  α-
carot
ene;i
sanant
i-
oxi
dant
cassaval eaves ,amar ant
h,pumpki n
t
hatpr
otec
tsc
ellmembr
ane.
,sweetpot at oes

Vit
aminC
(Asc
orbi
cAc
id) Frui
ts:Ci
trusf
rui
ts  Helpsthebodyusecal
cium and
othernutri
ent
stobuil
dbonesan
(
oranges
,gr
apef
rui
t,l
emons
,
thewallsofbl
oodvess
els.
t
anger
ines
,li
mes
),ber
ries
,paw  Hel
psf
ormc
oll
agen,whi
chi
s
paws
,mangos
,mel
ons
,guavas
, i
mpor
tantf
orc
onnec
tivet
iss
ues
t
omat
oes
,bananas
 I
ncr
eas
esabs
orpt
ionofi
ronf
rom
Greenveget
abl
es:Spi
nac
h, f
oods
.
c
abbage,br
occ
oli
,gr
eenpepper
s,  I
ncr
eas
esr
esi
stanc
etoi
nfec
tion.
Caul
ifl
ower
s,pot
atoes(
wit
hski
n),  Ant
ioxi
dant
.

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 pl
ant
ains
,young  Pr
otei
nmet
abol
ism.

mai
ze,s
prout
ed

VitaminD Produc edbyt heac tionoft hesun Facil

it
atescalc
ium andphos phor
us
(Cholecal
cif
erol
) ont hes kin. absorpti
on,util
izat
ion,and
Andal s
o maintenance(hencef or
mationof
Wheatger m,fi
sh,liver,egg bonesandt eet
h)
yolks,organmeat s
,c heese,milk
(breastmi l
k;mi l
kmayneedt obe
forti
fiedwi thvitami nD) ,butt
er,
mar garine,
mayonnai se
VitaminB12 Meat ,fi
s h,poult
ry,c heese,eggs,  Involvedi nthes ynthes
isofred
(Cobalamin) milk. bloodc el
lswhitebloodc el
ls.
 Mai ntenanc eofnervesand
NB.Cobalaminissynthesizedby digestivetiss
ues.
bact
eriainplant
s(e.g.i
nt he  Carbohydr at
emet aboli
sm.
nodulesofsomelegumes )and
ani
mal s.

Fol
ate Animalsources
:Liver
,eggs
,  I
nvolvedinsynthesi
sofredbl
oo
poul
tryandmeat. cel
ls.
 Maintenanc
eoft hener
vous
Greenl eafyveget
ables:Spi
nach, s
ystem.
Kale,l
egumes ,
Oranges,Whole  Metaboli
sm ofaminoacids
.
grainCerealsandnuts
.

I
ron Redmeat
,li
ver
,fi
sh,poul
try,  Oxygentransportat
ion
s
hel
lfi
shEggs
,legumes
,veget
abl
es,  Neededbyenzymes
f
rui
ts.  Absorpt
ionofvitaminC
 Energyproducti
on
NB.Phyt atesi
nc erealsand
vegetablesandt anni nsint eaand
coff
eedec reaseir onabs orption.
Ironinf oodboiledi nwat eri s
leachedandl osti ft
hewat eris
discarded.
Cal
cium
Mi l
k,yoghur t
,chees
e,greenleafy  St
rongbonesandt
eet
h.
vegetabl
ess uchasbroccoli
,
legumes,peas,fi
shwithbonest hat  Nor
malf
unc
tioni
ngoft
hehear
t.
areeaten.
 Hel
psi
nbl
oodc
lot
ting.

 Helpsmaint
ainnor
malbl
ood
press
ure.

Zi
nc Animalsources;Meat ,li
ver,  Pr
otec
tst
hei
mmunes
yst
em.
fi
sh,
poult
ry,eggs,milk,yoghurt
,  Neededfordi
ges
tiveEnzyme
seaf
oodincl
udings hell
fishand f
ormation.
oyst
ers
.
 Woundheal
ing.
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 Pl
ants
ources
:Cabbage,c
arr
ots
,  Vi
tami
nAmet
abol
ism.
s
pinac
h,beet
s,gr
eenpeas
,legumes
,  Normaldevel
opmentofmal
e
or
gans.
whol
egr
ainc
ereal
s,peanut
s,
 Ant
ioxi
dant
.
bar
ley.
 Componentofi
nsul
in.

I
NFANTI
LECOLI
C
BASICS
Coli
ci sdefinedasexc essivec ryingi nanot herwis ehealthybaby .Ac ommonlyused
cri
teriaistheWes selcriteriaort heRul eofThr ee,whenc r
yinglas t
sfor:
– >3hr /day
– >3days /
week
– Per s
ists>3weeks
Manyc l
iniciansdonots tri
ctlyadher et
ot hec rit
er i
onofper s
ist
enc efor>3weeks,as
few parentsorc linici
answi llwai tthatlongbef oreeval uati
onori ntervent
ion.
Somec l
inici
ansf eelthatc olicr epr esent
st heext remeendoft hes pectr
um ofnormal
crying,wher easmos tfeelthatc olicisadi st
inctclinicalentit
y.
Predomi nantagegr oupi sbet ween2weeksand4mont hsofage.
Equalpr edomi nanc eamongmal esandf emal es

ETI
OLOGY
Theexac
tcaus
eisunknown.Fac
tor
sthatmaypl
ayar
olei
ncl
udet
hef
oll
owi
ng:
Infantgas troesophagealr efl
uxdi s ease.
Aller gyt oc ow’smi lk,soymi lk,orbr eastmi lkpr ot
einFruitjuic
eintoleranc
e.
Swal lowi ngai rdur ingt hepr ocessofc rying,feeding,orsucking.
Over feedi ngorf eedingt ooqui ckly;under f
eedinghasal sobeenpr oposed.
Inadequat ebur pingaf terf eeding.
Fami lyt ension.
Par ent alanxi ety ,depres sion,and/ orf atiguePar ent–inf
antinteract
ionmi smatc
h.
Baby’ si nabi li
tyt oc onsol ehi m-orher s
elfwhendeal ingwiths t
imuli.
Incr eas esi ntheguthor monemot ilin,causinghyper peris
talsi
s.
Func tionall actos eover load( i.
e.,br eastmi l
kt hathasal owerl i
pidcontentcanhave
fastert rans i
ttimei nthei ntest
ine,l eadingt omor elact
osefermentationinthegut
andhenc egasanddi s
tens i
on).
Tobac cos mokeexpos ure.

CLINICALMANI FESTATIONS(SIGNSANDSYMPTOMS)OFANI NFANTILECOLIC.

Evaluati
onf orWes s
elcrit
eri
a:Cryinglast
sfor>3hr/
day
,>3days
/week,andpers
ist
s>3
weeks .
Episodesusuallyhaveac l
earbeginningandend.
Thec ryi
ngi sgeneral
lyspontaneous
,wi t
houtprec
edi
ngevent
str
iggeri
ngthe
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 epi
sodes .
Thecryingist ypic
allydiffer
entf r
om nor malcryi
ng.Coli
ckyc r
yingmaybel ouder
,
moretur bulent,variableinpitch,andappearsmor eli
kes cr
eami ng.Thei
nfantmay
bediff
icultt
os oot
heorc onsol
edes pit
ealloftheparents
’efforts
.
Theinfantac t
snor mal l
ywhennotc ol
icky.
Ass
esst hesuppor tsystem ofcaregiversandfamili
es,i
ncludingcopingski
ll
s.

MANAGEMENTOFANI
NFANTI
LECOLI
C.
GENERALMEASURES( WORLDHEALTHORGANI ZATI ON)
1.Soot hebyhol dingandr oc kingt hebaby.Us eapac ifi
er.
2.Us eofgent ler hythmi cmot ion(e.g.,s
troll
ers,i
nfants wings,carrides)
.
3.Plac enearwhi tenoi se(e.g.,vacuum c leaner,cl
othesdryer ,whit
enoi semac hi
ne).
4.Cribvi bratorsorc arrides imul atorshavenotpr oventobehel pful.
5.Incr eas edcar ryingorus eofi nfantc arri
erhasnotbeens hownt oi mpr ovecol
ic.
6.Bur pingdoesnots ignifi
cant lylowerc olicevents.Employt he5Ss( needt obe
donec oncurrent ly):
– Swaddl i
ng:tightwr appingwi thbl anket;maybees peci
allybenefici
alini nf
ants
<8weeksol d.
– Side:l ayingbabyons ide
– Shus hi ng:loudwhi tenoise
– Swi ngi ng:rhyt hmi c,ji
gglemot ion
– Suc king:onani ppl e,f
inger ,orpac ifi
er

MEDICATI ON
Nomedi cati
onhasbeenf oundt obeuniver
sall
ybenefici
ali
ntreati
nginfant
il
ecol
ic.
Probiot
icsaresafeandef fecti
ve.
Dicycl
omine(Bentyl
)hasbeenpr ovenbenefi
cial
,butthepotenti
alser
iousadver
seeffect
s,
suchasapnea, sei
zures,andsy ncope,haveprecl
udedi t
suse.
Furt
hermore,themanuf acturercontr
aindi
catedini
nfants<6mont hs.

WHENTOREFER?
Exces
sivevomit
ing,poorwei
ghtgai
n,rec
urr
entr
espi
rat
orydi
seas
es,orbl
oodys
tool
s
shoul
dpr omptref
erralt
oaspeci
ali
st.

FOLLOW- UPRECOMMENDATI ONS

Frequentout
pat
ientvi
sit
sasneededforpar
entalreas
sur
ance,educ
ati
on,and
monitori
ngandtoensuretheheal
thofthei
nfantandparent
s.

PatientMonitori
ng
Fol
low forpr
operfeedi
ng,gr
owt
h,anddevel
opment
.

DI
ET
Ifbr
eas
tfeedi
ng:
– Continuebreastf
eeding;s
wi t
chingtoformulaunl
ikel
yt ohel
p
– Possi
bletherapeuti
cbenefitfrom el
iminat
ingmil
kpr oduct
s,eggs
,wheat
,nut
s,
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 soy,and/orf i
s hfrom themat ernaldi
etofbr east
feedingmot hers.
I
fformul afeedi ng:
– Feedi ngt hei nfantinaver t
icalposi
tionusingac urvedbottleorbottl
ewith
coll
apsiblebagmayhel ptor educeairswallowing.
– I fnointer vent i
onordi et
aryc hangehasbeenef fecti
ve,considera1-weektr
ialof
hypoallergeni cformulassuchaswheyhydr ol
ysate(e.g.
,GoodSt ar
t)orcas
ein
hydrolysate( e.g.
,Ali
ment um,Nut ramigen,Pregesti
mi l)

PATI ENTEDUCATI ON
Reas surepar entsthatcoli
cisnott her esultofbadpar ent
ing,andadvi separents
abouthavi ngpr operrestbreaks,adequat es l
eep,andhelpinc ari
ngf ortheinfant.
Expl ainthes pectrum ofcryingbehavi or.Avoidover-orunder f
eeding.
Ins t
ructpar entsregardingbeneficialfeedingtechniquessuchasimpr ovedbottl
es
(low air,curved)ands uffi
cientbur pingaf t
erfeeding.

REFERENCES
1.Nutrit
iontrainer
'smanualandNutri
ti
onModul
ebyHeal t
hTutorsColl
egei
n
col
laborati
onwi thCol
legeofEduc
ati
onandExt
ernalSt
udiesMakerer
e
Universi
ty-2014.

2.Es sent ialsofNut ri

tionanddi ett herapybySueRos wel lWi l
liam ( 1990),5t
h
edition:Cal i
fornia.
3.Per s pec tivei nNut ritionbyGor donM.Wor dlow (1990) ,6thedi tion,Mc Graw
Hill:New Yor k.
4.J ohns tonM,Lander sS,Nobl eL,etal .Br eastf
eedi ngandt heus eofhumanmi lk.
Pedi atr i
cs .2012;129( 3):e827–e841.
5.Cent er sforDi seaseCont rolandPr eventi on.Breas t
fe edingRe por tCar d— United
State s,2014.At lanta,GA:Cent er sforDi seaseCont rolandPr event ion;2014.
http://www. cdc.gov/br eastf
eedi ng/pdf/2014br eastfeedi ngrepor tcard.pdf.
Ac cess edOc tober10,2023.
6.Si nus asK,Gagl iardiA.I nit
ialmanagementofbr eas tf
eeding.Am Fam Phys ician.
2001; 64( 6):981–988.
7.Cent er sforDi seaseCont rolandPr eventi on.Breas t
fe edingVac cinations.Atlanta,
GA:Cent er sforDi seas eCont rolandPr event i
on;2010.
http://www. cdc.gov/br eastf
eedi ng/recommendat ions /
vac cinations .
htm.
Ac cess edOc tober11,2023.
8. Ame ric anCol l
egeofObs tetri
c iansandGynec ol
ogi stsWomen’ sHeal thCar e
Phys icians ;Commi tteeonHeal thCar ef orUnder ser vedWomen.Commi tt
ee
Opi nionNo.570:br eas tf
eedingi nunder servedwomen:i nc r
eas ingi nit
iat
ion
andc
ont
inuat
ionofbr
eas
tfeedi
ng.Obs
tetGyne
c .2
ol 013;
122(
2,Pt1)
:423–
428.

22/
U/20823/
HTP.
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.7.
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