Module 4: Breastfeeding and Infant Nutrition

Receiving proper nutrition during the first two years of life is vital for the healthy growth and development of a child. It has been particularly noted that healthy height and stature at two years is the best predictor of educational and economic success.(1) Breast milk provides many nutritional benefits to a child and contains anti-infective properties that protect newborns from early infection.(2) Breastfeeding serves as an important component of infant nutrition and should be considered in topics of research and policy to address infant mortality and morbidity. 

Optimal breastfeeding practices promote healthy growth and development of newborns. International recommendations for breastfeeding practices, as based on clinical and epidemiological evidence, are to exclusively breastfeed for six months and follow with a transitional introduction to complementary foods.(3) The WHO highly recommends exclusive breastfeeding for six months and appropriate complementary feeding practices as the best ways to prevent infant malnutrition. It is encouraged to continue breastfeeding until the child is three years old. 

Suboptimal breastfeeding practices may threaten infant health. Discarding colostrum (the first milk produced during lactation that contains antibodies necessary to protect newborns from infection), using pre-lacteal feeds (such as honey or sugar water), early introduction of formula, and early weaning (usually before six months old) are associated with infant illness and mortality.(4)(5) Unfortunately, the prevalence of suboptimal breastfeeding practices is high in developing countries.(6) In Africa, Asia, Latin America, and the Caribbean, only 25 to 31% of infants from 2 to 5 months old are exclusively breastfed.(7)  

In developing countries, the lack of exclusive breastfeeding for six months and absence of breastfeeding for infants 6 to 23 months old is associated with higher risk of diarrheal infections and associated morbidity and mortality.(8) This is substantial, given that diarrheal diseases are the second leading cause of death for children under 5 and are the cause of 1.34 million childhood deaths worldwide.(9) The immunological benefits of breast milk can help protect children from infection and prevent disease. 

Breastfeeding promotion schemes have been shown to improve exclusive breastfeeding rates at 4 to 6 weeks and at 6 months.(10) A Cochrane Review has shown that breastfeeding interventions and support can reduce the discontinuation of exclusive breastfeeding practices at 4 to 6 weeks by 33%.(11) These findings support the notion that optimal breastfeeding practices can be instated in a population with proper focus and promotion of nutrition interventions. As always, it is necessary to recognize the existing social and cultural aspects of practices for effective intervention strategies, since women in developing countries may have perspectives that conflict with Western ideology.

Footnotes

(1) Victora, C.G., Adair, L., Fall, C., Hallal, P.C., Martorell, R., Richter, L., et al. (2008). Maternal and child undernutrition: consequences for adult health and human capital. The Lancet, 371(9609): 340-357.

(2) Sellen, D.W. (2007). Evolution of infant and young child feeding: implications for contemporary public health. Annual Review of Nutrition, 27: 123-148.

(3) Ibid. 

(4) Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, & Bellagio Child Survival Study Group. (2003) How many child deaths can we prevent this year? The Lancet 362:65–71

(5) Lamberti, L.M., Walker, C.L.F., Noiman, A., Victora, C., & Black, R.E. (2011). Breastfeeding and the risk for diarrhea morbidity and mortality.  BMC Public Health, 11(S3): S15-27.

(6) Imdad, A., Yakoob, M.Y., & Bhutta, Z.A. (2011). Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health, 11(S3):S24-32.

(7) Black, R.E., Allen, L.H., Bhutta, Z.A, Caulfield, L.E., de Onis, M., Ezzati, M. et al. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 371: 243-260.

(8) Lamberti, L.M., Walker, C.L.F., Noiman, A., Victora, C., & Black, R.E. (2011). Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health, 11(S3): S15-27.

(9) Black, R.E., Cousens, S., Johnson, H.L., Lawn, J.E., Rudan, I., Bassani, D.G., et al. (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet, 375: 1969-1987.

(10) Imdad, A., Yakoob, M.Y., & Bhutta, Z.A. (2011). Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health, 11(S3):S24-32.

(11) Ibid.