Breastfeeding 95
2
family. The health profession has an important
role in educating and supporting the mother in
breastfeeding. Traditional hospital routines with
separation of the mother and the infant, sched-
uled feeding intervals and provision of other
drinks have a negative impact on the prevalence
of breastfeeding. This is the reason why the
UNICEF and WHO launched the Baby-Friendly
Hospital Initiative in 1992. By training hospital
staff in the 10 steps to successful breastfeeding
( table 2 ) it has been possible to increase breast-
feeding rates in many settings. Health profession-
als should also be trained in solving common
problems during the first days after delivery, like
positioning of the infant, sore nipples and suck-
ing difficulties. To stop the negative influence of
marketing of infant formulae, the World Health
Assembly has adopted the International Code of
Marketing of Breast-Milk Substitutes (Chapter
2.3).
Breastfeeding of Preterm Infants
Breastfeeding is especially important for preterm
infants because human milk appears to have a
protective effect on the immature gut and reduces
the risk of necrotizing enterocolitis. Preterm in-
fants have a higher protein need, which should be
covered by adding an appropriate human milk
fortifier (Chapter 3.14). If the mother cannot sup-
ply milk for her infant, provision of donor milk
should be considered. This could be provided by
individual donors or from a human milk bank. If
donor milk is used, there are a number of proce-
dures regarding testing, storage and pasteuriza-
tion that have to be followed [3].Conclusions- Populations of breastfed infants have fewer in-
fections, and most likely fewer immune-relat-
ed diseases such as asthma, diabetes and in-
flammatory bowel diseases, a small advantage
in cognitive development and some protection
against noncommunicable diseases (e.g. obe-
sity) - For the mother, breastfeeding results in lacta-
tional amenorrhea, child spacing – which is
important in populations with low use of con-
traceptives – and a reduced risk of breast and
ovarian cancer and type 2 diabetes - Feeding of human milk to preterm infants
protects the immature gut and decreases the
risk of necrotizing enterocolitis. If the mother
cannot provide breast milk, provision of do-
nor milk should be considered
Ta b l e 2. WHO/UNICEF: Ten steps to successful breastfeeding- Have a written breastfeeding policy that is routinely communicated to all health care staff
- Train all health care staff in skills necessary to implement this policy
- Inform all pregnant women about the benefits and management of breastfeeding
- Help mothers initiate breastfeeding within 0.5 h of birth
- Show mothers how to breastfeed and maintain lactation, even if they should be separated
from their infants - Give newborn infants no food or drink other than breast milk, unless medically indicated
- Practice rooming in – that is, allow mothers and infants to remain together 24 h a day
- Encourage breastfeeding on demand
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
- Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 92–96
DOI: 10.1159/000360323