IAP POLICY ON INFANT FEEDING

Background

Appropriate nutritional practices play a pivotal role in determining optimal health and development of infants concerned by the lack of uniform guidelines for appropriate infant feeding practces in the India context, the IAP Subspeciality Chapter on Nutrition conducted a Workshop to define a policy on Infant Feeding (Appendix). Subsequently, these recommendations were endoresed as the official Indian Academy of Pediatrics Policy on Infant Feeding and as National Guidelines on Infant Feeding by the Food and Nutrition Board, Department of Women and Child Development, Ministry of Human Resource Development, Government of India.

Contents of theIAP Policy on Infant Feeding
Indeal infant feeding comprises exclusive breastfeeding for 6 months followed by sequential addition of semi-solid and solid foods to complement (not replace) breastmilk till the child is gradually abe to eat normal family food (around one year). The latter period is also referred to as weaning. The term weaning doed not denote termination of breastfeeding. Appropriate feeding is crucial for the healthy growth and development of the infant. However, lack of confidence and widespread ignorance and misconceptions frequently result in improper management of infant feeding. The prominent areas of concern include discarding or minimal feeding of colostrum or delayed iniitation of breastfeeding by nearly 80% of mothers, non exclusive breastfeeding by 85-90% in the first six months of life, unnecessary utilization of commercial infant milk foods and animal milks and premature or delayed introduction of semi-solids which may be contaminated, low in caloric density and fed less frequently. These inept feeding practices, directly or indirectly, contribute substantially to infectious illnesses, malnutrition and mortality in infants. The Policy on Infant Feeding aims at promotion of suitable practices to advance child care, growth and development, reduce the prevalence of protein energy malnutrition (PEM), Vitamin A deficiency and infectious disease, particularly diarrhea, and improve survival. The Policy focuses on the strategy of educating and motivating the families to adopt proper infant feeding methods through the existing health infrastructure and other development programmes for women and children.

1. Appropriate Infant Feeding Practices
   1. Breastfeeding
      1. Advantages of Breastfeeding
         It is a proven scientific fact that all commerical infant milk foods and animal milks are inferior to breasmilk: (1) Maternal milk is nutritious food for infants to feed, hygienic, develops emotional bonding and prevents allergic disorders; (ii) Breastfeeding protects against several infections including diarrhea and respiratory infections, and saves lives. An exclusively breastfed infant is about 14 times less likely to die from diarrhea, 3 to 4 times less likely to die from respiratory disease and 2 to 3 times less likely to die from other infections than a non breastfed infant; (iii) Breast milk is much more economical than artificial milk or powdered milk food - the average cost of feeding a 6 month old infant for one month on infant formula may even be equal to the average monthly per capita income; (iv) "Exclusive" breastfeeding exerts strong contraceptive effect in the first 6 months post partum; (v) Maternal benefits include earlier termination of post partum bleeding and protective effect against breast and ovarian cancer.
      2. Preparation for Breastfeeding During Pregnancy
         The expectant mothers, particularly primiparas and those experiencing difficulties with lactation management earlier, should be motivated and prepared to exclusivelybreastfeed. This should be achieved by educating, through a personal approach, about the benefits and management of breastfeeding. In the last trimester of pregnancy, breast and nipples should be examined and relevant advise given. Expectant mothers should be counseled to eat an extra green vegetables. Additioanal rest of half to one hour and wherever possible, switching to relatively lighter work during the last trimester should be propagated.
      3. Starting Breastfeeds.
         Practically all mothers, including those with mild to moderate chronic malnutritions, can successfully breastfeed. Soon after delivery, the mother should be allowed to keep the newborn with her (rooming-in). After a normal delivery, babaies should receive the first breeastfeed as soon as possible an preferably within one hour of birth. During this period and later, the normal newborn should not be given any other fluid or food like honey, "ghutti", animal or powdered milk, tea, water, glucose water etc. since these are potentially harmful. It is essential that the baby gets the first breastmilk called colostrum which is thicker and yellower than later milk and comes only in small amounts in the first few days. Colostrum is all the food and fluid needed at this time - no supplements are necessary, not even water. The mother, especially with the first birth, may need help in the proper positioning for breastfeeding. Breastfeeds should be given as often as the baby desires and each feed should continue foe as long as the infant wants to suckle. After a cesarean section, breaftfeeding should be started as soon as possible and preferably within 24 hours of delivery. The mother will need help to put the baby to the breast for a day or two.
      4. Exclusive Breastfeeding
         Druing the first few months and as far as possible, till the age of 6 months, "exclusive" breastfeeding shoudl be practiced; young infants do nto require any additional food or water or any other fluid such as tea, herbal water, glucose water, fruit drinks, etc. Breastmilk alone is adequate to meet the hydration requirements even under extremely hot and dry summer conditions of the country.
      5. Diet of Lactating Mother
         A lactating woman should be advised to eat an extra helping of the family fod and regular consumption of green leafy vegetables. There is no need to avoid any specific foods; however, use of excessive caffeine, tobacco, and alcohol etc. should be discouraged.
      6. Important Special Situations
         
         1. Low Birth Weight Infants
            Mother's milk is the best food for the low birth weight babies. The borderline term and growth retarted low birth weight babies can suckle fairly well at the breast and should be given expressed breastmilk in preference to formula feeds by appropriate techniques such as clean cup and spoon, tubes, "paladai" etc. The child should be put directly to the breast as soon as possible.
         2. Common Illnesses in the infant.
            Breastmilk is the most easily digestible food for an ill baby. Feeding
            
            common infantile ailments including diarrhea and acute respiratory infections. Breastfeeding must, therefore, be ensured during such illnesses. The children may suckle less vigorously or for a shorter time and should receive the feeds at more frequent intervals. However, breastfeeding adn for that matter, any type of feeding should not be attempted in critically ill infants.
         3. Illness in Mother
            Most common maternal illnesses do not require discontinuation of breast feeding. Breastfeeding is recommended even with mastitis, breast abscess and other infectious illnesses including urinary tract infection, tuberculosis, human immunodeficiency virus (AIDS), physically incapacitating systemic illnesses may prevent or necessitate discontinuation of breastfeeding. Psychosis is a contraindication for breastfeeding on account of abnormal maternal behavior. In such situations, whereve feasible, the breasts should be emptied frequently to maintain lactation.
         4. Drug intake in Mother
            Drug therapy shoudl be avoided in lactating mothers and when necessary, a safer alternative should be prescribed. Drug intake should preferably be timed during or immediately after breastfeeding. Majority of the commonly used preparations are compatible with safe breastfeeding. Only a few drugs necessitate discontinuation fo breastfeeding like anti cancer and anti thyroid therapy, radioactive preparations, ergot, gold salts, lithium, etc.
         5. Breastfeeding Subtitutes
            If a mother can not for some reason exclusively brastfeed her young infant (below 6 months age), for example a working mother, her expressed milk shoul be given to the baby in preference to other animal or formula milks.
            
            Rarely, if it is unavoidable - at least partially - to give non human milk in the first 6 months of life, undiluted milk normally be utilized and commercial infant milk foods should be strongly discouraged. In infants, part of excessive fat in buffalo’s milk should be removed by separating the cream from milk after boiling and cooling to room temperature. Young infants