INTRODUCTION

BREAST FEEDING

Breastfeeding, also known as nursing, is the feeding of babies and young children with

milk from a woman's breast. Health professionals recommend that breastfeeding begin within the

first hour of a baby's life and continue as often and as much as the baby wants. During the first

few weeks of life babies may nurse roughly every two to three hours. The duration of a feeding

is usually ten to fifteen minutes on each breast. Older children feed less often. Mothers may

pump milk so that it can be used later when breastfeeding is not possible. Breastfeeding has a

number of benefits to both mother and baby, which infant formula lacks. Deaths of an estimated

820,000 children under the age of five could be prevented globally every year with increased

breastfeeding. Breastfeeding decreases the risk of respiratory tract infections and diarrhea, both

in developing and developed countries. Other benefits include lower risks of asthma, food

allergies, celiac disease, type 1diabetes, and leukemia. Breastfeeding may also improve cognitive

development and decrease the risk of obesity in adulthood. Mothers may feel pressure to

breastfeed; however in the developed world children generally grow up normally when bottle

feed.

Benefits for the mother include less blood loss following delivery, better uterus

shrinkage, weight loss, and less postpartum depression. Breastfeeding delays the return of

menstruation and fertility, a phenomenon known as lactation amenorrhea. Long term benefits for

the mother include decreased risk of breast cancer, cardiovascular disease, and rheumatoid

arthritis. Breastfeeding is often less expensive than infant formula.

breastfeeding exclusively for six months. This means that no other foods or drinks other than

possibly vitamin D are typically given. After the introduction of foods at six months of age,

recommendations include continued breastfeeding until at least one to two years of age. Globally

about 38% of infants are only breastfed during their first six months of life. In the United States,

about 75% of women begin breastfeeding and about 13% only breastfeed until the age of six

months. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain

recreational drugs and medications should not breastfeed. Smoking, limited intake of alcohol,

and coffee are not reasons to avoid breastfeeding {WHO 2007}.

EXCLUSIVE BREAST FEEDING

Exclusive breastfeeding is defined as "an infant's consumption of human milk with no

supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for

vitamins, minerals and medications." Exclusive breastfeeding till six months of age helps to

protect an infant from gastrointestinal infections in both developing and industrialized countries.

The risk of death due to diarrhea and other infections increases when babies are either partially

breastfed or not breastfed at all.

BREAST MILK

The composition of breast milk changes depending on how long the baby nurses at each

session, as well as on the child's age. The first type, produced during the first days after

childbirth, is called colostrum. Colostrum is easy to digest although it is more concentrated than

normal milk. It has a laxative effect that helps the infant to pass early stools, aiding in the

excretion of excess bilirubin, which helps to prevent jaundice. It also helps to seal the
infantsgastrointestional tract from foreign substances, which may sensitize the baby to foods that

the mother has eaten. Although the baby has received some antibodies through the placenta,

colostrum contains a substance which is new to the newborn, secretory immunoglobulin A (IgA).

IgA works to attack germs in the mucous membranes of the throat, lungs, and intestines, which

are most likely to come under attack from germs.

Breasts begin producing mature milk from the mother around the third or fourth days

after birth. Early in a nursing session, the breasts produce foremilk, a thinner milk containing

many proteins and vitamins. If the baby keeps nursing, then hindmilk is produced. Hindmilk has

a creamier colour and texture because it contains more fat. The American Academy of Pediatrics

(AAP) states that "tobacco smoking by mothers is not a contraindication to breastfeeding." In

addition, AAP states that while breastfeeding mothers "should avoid the use of alcoholic

beverages", an "occasional celebratory single, little alcoholic drink is acceptable, but

breastfeeding should be avoided for 2 hours after the drink." A 2014 review found that "even in a

theoretical case of binge drinking, the children would not be subjected to clinically relevant

amounts of alcohol [through breastmilk]", and would have no adverse effects on children as long

as drinking is "occasional".

THE NUTRITIONAL CONTENT OF BREAST MILK

Lactose: - This lactose being a special sugar in breast milk. It is only carbohydrate in milk.

Lactose provide energy and help in the absorption of calcium. Breast milk contain more lactose

than any other milk. Babies and young children have a special enzyme “lactase” in the intestine

to digest lactose, but in the first few month of life, babies do not have a enough of enzymes

“amglase” needed to digest starch thus it is difficult for every young baby to digest food made

from cereals {WHO 2005}.

– unsaturated and essential fatty acids made from cereal do not contain enough fat, so they

provide too little energy. The amount of different fatty acids in breast milk depends partly on the

mother diets and there may be slightly less fat if the mother is severely malnourished. The fats in

human milk is easier to digest because milk contain an enzyme {lipase which helps to digest fat,

while animal milk do not contain lipase}

Protein: - The protein in breast milk forms soft curds in the baby’s to digest, the protein in

artificial milk form thick curds in the baby’s of the amino acids taming which may be important

for growth of the babies brain while cow milk do not contain enough taming for a baby, and

formulae manufacture have to add extra.

Vitamin: -Milk from well – nourished mothers contain enough vitamins. The baby does not

need extra vitamins. In case if a mother is undernourished, there may be loss of some vitamins in

her milk for example, vitamin A, yet her milk still remain the best for her baby.

Mineral: - Breast milk contain right amount of salt, calcium and phosphate for a baby, cow milk

contain too much of these mineral and they can make a baby ill. Breast milk and cow milk both

contain same amount of iron, but the iron from breast is well absorbed while that from cow milk

not well absorbed. Breast fed babies do not become an anatic except for some other reasons like

congenital problem, low birth weight, but artificial feds babies may become anaemic.

Manufactures often added extra formulae to prevent anaemia but added iron helps bacteria to

grow and increase the risk of infection. Breast milk do not help bacteria growth.

Water: - Breast milk contain enough water for a baby, it is not necessary to give a baby extra

water, even in hot, day climate. If baby is thirsty, he or she can breast feed more often than usual.
Artificial fed babies may need extra water to help them excrete salt and wasted amino acids in

animal milk.

Anti-Infective Factor: - Breast milk contains living anti – infective factors which protect baby

against infection. These are

i. Living white blood cells which helps to kill bacterial and viruses

ii. Antibodies which covens the surface of the gut and prevent micro organism getting into the

blood. If mothers get an infection, her breast milk contain antibodies against that new

infection.

iii. Other factors for example, the “bifidus” factors which helps harmless bacteria called

lactobacillus bifidus to growth in the baby’s gut. This bacteria prevents the growth of more

harmful bacteria and gives the faces of breast fed babies “yoghurt” smell.

Breast milk is always safe and clean, It never goes bad in the breast even when they mother were

not breast fed for some day Expressed breast milk remains safe for at least 8 hours even in hot

climate and even if it is not refrigerated. Artificial feed do not contain these antibodies factors so

they do not protect babies against infection. Artificial fed babies, even if the feeds are cleanly

prepared, they may be contaminated and the baby is even more likely to have diarrhea.

IMPORTANT OF BREAST FEEDING TO BABY

Early breastfeeding is associated with fewer night-time feeding problems. Early skin-to-

skin contact between mother and baby improves breastfeeding outcomes, increases cardio-

respiratory stability and decreases infant crying. Reviews from 2007 found numerous benefits.

Breastfeeding aids general health, growth and development in the infant. Infants who are not

breastfed are at mildly increased risk of developing acute and chronic diseases, including lower
respiratory infection, ear infections, bacteremia, bacterial meningitis, botulism, urinary tract

infection and necrotizing enterocolitis. Breastfeeding may protect against sudden infant death

syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma,

allergic diseases, digestive diseases and may enhance cognitive development.

Growth: - The average breastfed baby doubles its birth weight in 5 to 6 months. By one year, a

typical breastfed baby weighs about 2½ times its birth weight. At one year, breastfed babies tend

to be leaner than formula-fed babies, which improves long-run health.

Mortality: - Babies who are not breastfed are almost six times more likely to die by the age of

one month than those who receive at least some breast milk

Diabetes: Breastfeeding of babies is associated with a lower chance of developing diabetes

mellitus type 1. Breastfed babies also appear to have a lower likelihood of developing diabetes

mellitus type 2 later in life. Breastfeeding is also associated with a lower risk of type 2 diabetes

among mothers who practice it.

Childhood obesity: - The protective effect of breastfeeding against obesity is consistent, though

small, across many studies. A 2013 longitudinal study reported less obesity at ages two and four

years among infants who were breastfed for at least four months.

Allergic diseases: - In children who are at risk for developing allergic diseases (defined as at

least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through

4-month exclusive breastfeeding, though these benefits may not persist.

against celiac disease among at-risk children. Breast milk of healthy human mothers who eat

gluten-containing foods presents high levels of non-degraded gliadin (the main gluten protein).

Early introduction of traces of gluten in babies to potentially induce tolerance doesn't reduce the

risk of developing celiac disease. Delaying the introduction of gluten does not prevent, but is

associated with a delayed onset of the disease {WHO 2001}.

NUTRITIONAL AND HEALTH IMPORTANCE OF EXCLUSIVE BREAST FEEDING

TO MOTHER

Breastfeeding aids maternal physical and emotional health. Breastfeeding and depression

in the mother are associated. Mothers who successfully breastfeed are less likely to develop

postpartum depression {Nyles 1971}.

Maternal bond: Hormones released during breastfeeding help to strengthen the maternal bond.

Teaching partners how to manage common difficulties is associated with higher breastfeeding

rates. Support for a breastfeeding mother can strengthen familial bonds and help build a paternal

bond.

Fertility: - Exclusive breastfeeding usually delays the return of fertility through lactational

amenorrhea, although it does not provide reliable birth control. Breastfeeding may delay the

return to fertility for some women by suppressing ovulation. Mothers may not ovulate, or have

regular periods, during the entire lactation period. The non-ovulating period varies by individual.

This has been used as natural contraception, with greater than 98% effectiveness during the first

six months after birth if specific nursing behaviors are followed.

prolactin hormones relax the mother and increase her nurturing response.

FACTORS AFFECTINGNURSING-MOTHERS TO ADEQUATEBREAST-FEEDING

Level of Knowledge On Breast Feeding

Having adequate information about breast feeding and failing to experience problem during

breast feeding period are found to influence mother to breast feed their infant. One of the

elements to empower a woman to breast feed is that she has sufficient knowledge to make

decision (Shelton, 2014). Breast feeding choice and success are usually associated with higher

knowledge on breast feeding (Wallace 2016)

HIV Status The Fear Of Transmitting

Hiv through breast milk is a factor that contributes to the decline in breast feeding. HIV-

positive mothers could be targeted by the distributors of infant food products. A four country

study on breastfeeding in selected African countries concluded that there has been a reduction on

support of breast feeding as a result of term and misinterpretation of the

UNAIDS/WHO/UNICEF guidance related to HIV and breast feeding (Miriam et al., 2015)

Possible explanations include a reduction in dietary antigen and pathogens which are assumed to

provoke an inflammatory responses or altar infants gut integrity. The promotion of beneficiary

intestinal micro flora by breast milk which may increase resistance to infection (Caltsoudius et

al., 2016)

Marital Status

Single mother have great difficulty supporting themselves and carting for the baby especially

if they are young, single mother have less family support. Without this support, activities outside

the home such as having to work might prevent EBF. It is often best if the mother and the baby
can stay together and be supported as a family. They can breast feeding at least partially

(Ebrahim,2015).

Education

A women educational and social class affects her motivation to breast feed but the way it

affects is different parts of the world. In may industrialized countries in the west, breast feeding

is more common among the educated and upper class women. On the other hand, in third world

countries the educated and upper class women are more likely to feed their infant artificially.

Generally educated women tend to breast feed less and are likely to introduce supplementary

feeding earlier than those with little or no education. This is attributed to the fact that a better

educated woman is more likely to work away from home which makes breast feeding difficult

(LUAN2015). The KDHS 2015, found an inverse relationship between education and main

duration of breast feeding.

Employment

A woman may choose not to breastfeed because she plans to go back to work outside home

soon after the baby is born and feels it is too difficult to work and also breast feed. Other woman

find it hard to maintain their milk supply when separated from their babies and may be forced to

stop breast feeding. Maternal employment outside the home is often acted as a major factor in

short term breast feeding pattern seen throughout the world {Perry 2016}.

Cultural Factor

The decision to breast feed is very often influenced more by socio-cultural factor than by

health consideration (hinder son et al 2016). Noted that cultural beliefs have a significant

influence on breast feeding practices. When perceives primarily as sex symbol, the breasts must

be decently hidden which makes breast feeding in public place or in the presence of friend is an
activity that is extremely sensitive to cultural norms. Finding of the study done among women in

Hong Kong showed that majority of the women agreed that it was unacceptable to breast feed in

front of others except the husband are worker(Kong et al, 2014). Society has stressed modesty

and frowned on baring breasts in public even in so good a cause as nourishing babies (Freed,

2001). In most African countries, breast feeding is still considered an important part of the

traditional culture and is actively supported and promoted by community member (Walker et al,

2015)

ADVANTAGES OF BREAST FEEDING FOR THE INFANT

1. Provision of essential and adequate nutrient to the infant at the night temperature and with

minimum stress to the absorptive capacities of the baby.

2. Reduce the sickness rate of children e.g. gastroenteritis and respiratory infections.

3. Reduces the incidence of allergic disorders

4. Provides bonding between the mother and child hence improving the psychological

development of the child.

THE TEN STEPS TO SUCCESSFUL BREASTFEEDING

Every facility providing material service about care for new born infant should:

1. Have a written breast feeding policy that is routinely communicated to all health care

staff

2. Train all health care staff in skill necessary to implement this policy

3. Inform all pregnant women about the benefit and management of breast feeding

4. Help mother initiate breast feeding within a half hour birth

5. Show mother how to breast feed and how-to maintain lactation even if they should be

separated from their infants.

7. Practice homing in: allow mother and infant to remain together 24 hour a day.

8. Encourage breast feeding on demand

9. Give no artificial teats or pacifiers (also called dummies or so others) to breast feeding

infants

CONCLUSION

Breastfeeding is very crucial for the health of babies as mixed feeding result in disease among

babies despites the health education done at hospital and communities on awareness of exclusive

breastfeeding up to six months, mother are reluctant to stick to the teaching. Failure to follow

exclusive breastfeeding is attributed to social, cultural and religious factor which promote other

feeding as a way of safe keeping of the babies. Working mother also showed that they have a

problem in exclusive breast feeding their babies since the maternity leave is short and they will

have to supplement breast milk with other feeds when they are at work which includes porridge

and baby milk bought in shops. The greater number of child bearing mother is aged between 20-

30 years. And some researches reveal that some mothers are literate.

One of the greatest factor influencing the attitude of mother towards breastfeeding is their level

of education, it is seen to have contributed positively to the acceptance and practice of

breastfeeding. Again despite their knowledge about exclusive breastfeeding, many of them still

have poor knowledge about colostrums.

In a way to moderate the influence of breastfeeding to a child, the following

recommendations are explore for mothers to increase breast-feeding activities:

1. Formation of social support on breast feeding

2. Nursing mother working hour should be reduced to half a working day for the period of one

year after delivery to enable the mother care adequately for their child.

3. To reduce rate causes of malnutrition, early introduction of complementary food to infant by

mother should be discouraged.

4. I advice that the employers should give tier employee six month maternity leaves.

GOVERNMENT’

1. The teaching about exclusive breastfeeding should be integrated into the school curriculum at

all level as young people tend to practice what they learn at the younger ages.

2. There is a great need for health education to explain to explain to mothers, the importance of

breast feeding the child on demand to sustain the quantity of breast milk production.

3. All mother, irrespective of their age, marital status, education level and employment status

should be encourage to exclusively breastfeed their infant, public forum should be used as a

channel to promote exclusive breast feeding.

4. Staff in the ministry of public health concerned with child health should be more aggressive

in implementing the existing policy on exclusive breast feeding, its recommended period and

its health benefit both for the mother and infants.

5. Health worker especially rules should try and leave by examples it is discouraging for nurses

to preach about exclusive breastfeeding while they themselves do not practice it.
 REFERENCES

1. Azubuike, Jc C (2017): infants feeding in pediatrics and child health in a tropical region,

African educational service P 155-161.

2. Boye and felicity et al (2015): knowledge attitude and practice of health worker in keff

local government hospital regarding baby friendly hospital initiative (BFHI) practice.

European journal of clinical nutrition, world health organization, exclusive breastfeeding.

3. Butte N.F lpez- alarm M.G and Cuthbert G hhp:/www. Who.int. 2018 human milk intake

during exclusive breastfeeding for the them infant during exclusive breast feeding in the

first year of life.

4. Chavdasama, patal, kavishwerd, aundelmanetal (13 09 2017) knowledge attitude and

practice of breastfeeding in the north of Jordan a cross sectional study.

5. Cuguwu, G.O (2009: attitude and practice of exclusive breastfeeding amongst mother In

Enugu. Unpublished

Ebrahim, E.c 2015: examination in community medicines, university of Nigeria, Enugu,

sonashah, Rollin N.C and bland R. breastfeeding knowledge among health worker in rural South

Africa journal of tropical pediatrics, 51: 33-38.