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Human breast milk is the best food for newborn babies. In December 1997, the American Academy of Pediatrics issued a policy statement advocating breast milk as the ideal, exclusive food for babies in the first six months of life. They also recommended that breast-feeding continue for at least 12 months or longer if mutually desired.1
In the United States, only about 50% of new mothers giving birth in a hospital breast-feed their babies. This number declines rapidly, with only about 20% of women still breast-feeding at six months.2 There is a large body of evidence on the benefits of breast-feeding for both mother and infant. With adequate support and good information on preventing some of the common problems associated with breast-feeding, a woman's chances of successfully breast-feeding her new baby are greatly improved.
Breast feeding provides significant benefits for baby and mother.
Benefits for baby
Human milk contains the ideal balance of nutrients, enzymes, and anti-infective and immune supportive agents for babies.3, 4 There are two kinds of breast milk: colostrum and mature milk. Colostrum, which is produced in the first few days after birth, has higher concentrations of protein and immune-enhancing agents and less sugar and fat than mature milk.5 Mature human milk differs greatly from both infant formula and either cow or goat milk. Human milk, made specifically for the nutritional needs of the newborn, is superior to all alternatives.
One significant advantage of human breast milk is its abundance of immune-protective and anti-infective agents, including immunoglobulins (primarily immunoglobulin A, or IgA), lactoferrin, Bifidobacterium bifidum, white blood cells, and other factors. These agents are known to help the newborn fight a wide variety of illnesses. Many scientific studies in the United States and other developed countries have demonstrated the health protective benefits of breast milk.
Breast-feeding has been found to help prevent: diarrhea,6, 7, 8, 9, 10 lower respiratory tract infection,11, 12, 13, 14ear infections (otitis media),15, 16, 17, 18, 19, 20 meningitis,21, 22urinary tract infection,23 and other serious infections (botulism, necrotizing enterocolitis, bacteremia).24, 25, 26, 27, 28 In addition, breast-feeding may possibly help prevent: sudden infant death syndrome (SIDS),29, 30, 31 insulin-dependent diabetes mellitus,32, 33Crohn's disease, ulcerative colitis,34, 35cancer (lymphoma),36, 37 allergic diseases,38, 39, 40 and other chronic digestive diseases.41, 42, 43 Breast-feeding may also enhance cognitive development.44, 45
The protein composition of breast milk is perfect for growing babies and is easy for them to digest. Breast milk also provides absorbable nutrients; the iron and zinc found in human milk is extremely easily absorbed (bioavailable) compared with iron and zinc from other foods. When infants are exclusively breast-fed, 50% of the iron is absorbed. By comparison, absorption of iron from cow's milk and iron-fortified commercial formula is much lower, only 10% and 4%, respectively.46
Breast milk is also quick, easy, and cost-effective. It's always available and does not need to be prepared, and the cost of providing the necessary additional nutrition to a breast-feeding mother is about half the cost of commercial formula.47, 48, 49 And breast-feeding promotes bonding, allowing a mother and her baby to be in close physical contact, enhancing the formation of a close mother-baby bond.50
Benefits for mother
Breast-feeding a new baby has many important health benefits for the mother as well. Breast-feeding immediately after childbirth causes the release of a hormone called oxytocin, which causes the uterus to contract. This results in less postpartum (after pregnancy) blood loss and a more rapid return of the uterus to its pre-pregnancy size.51 While breast-feeding, most women will not immediately resume their ovulation and menstrual periods. Delaying the return of ovulation may extend the time between pregnancies.52, 53 Women who breast-feed for at least six months lose weight more quickly than women who continue breast-feeding for less than three months.54 And, while breast-feeding can cause a short-term loss of bone density, it also seems to improve the body's ability to rebuild bones postpartum.55 In addition, women who have breast-fed their babies may have fewer osteoporosis-linked hip fractures after they've passed through menopause.56 Breast-feeding has also been associated with a lower risk of ovarian cancer and a reduced risk of breast cancer in premenopausal women.57, 58
What conditions are related to breast-feeding?
Several problems common to breast-feeding mothers can be prevented or eased through simple techniques or addressed with common, simple treatment options.
Most women will experience some degree of nipple soreness in the first days of breast-feeding. Discomfort that occurs at the onset of breast-feeding and is relieved by feeding is normal. It is caused by the stimulation of the nipple by the hormone oxytocin, which stimulates milk let-down. True nipple soreness, in which the nipples appear red and are tender to the touch, is rare and is probably caused by the baby's improper grasp on the nipple and areola (pigmented area surrounding the nipple) while feeding.
Correcting the baby's position on the breast is the most important tactic for preventing and relieving sore nipples. A physician, nurse, or lactation consultant can assist in assessing and correcting an infant's grasp of the nipple. Sore nipples can progress to more painful, cracked, and fissured nipples. As the condition worsens, the nipples are more susceptible to infection. In addition to correcting the baby's position, there are a number of self-help measures frequently recommended for the relief of sore nipples. These are most effective when begun at the onset of symptoms.
Check the position of the baby on the breast; the infant's tongue should be under the nipple and the mouth should grasp both the nipple and part of the areola. Vary the position of the breast-feeding infant with each feeding to avoid soreness of a particular area of the nipple.
The infant should be fed on demand; an overly hungry infant may suck harder, causing nipple soreness. Mothers with sore nipples should begin each feeding on the side that is least sore, switching to the sore breast after the let-down reflex has occurred. The infant should not be allowed to suck on an empty breast, which can cause damage to the nipple. If the nipples are sore, a breast-feeding session of ten minutes on each side should be sufficient to nourish the baby.
Ice packs applied to the breasts prior to breast-feeding can have a pain-relieving effect. Allowing nipples to air-dry after nursing can help to reduce nipple soreness.
In the case of cracked nipples, the application of an ointment or cream can aid healing. Ointments or creams allow the skin's internal moisture to heal deep cracks and fissures while keeping the skin pliable.59 A frequently recommended and safe ointment for cracked nipples is medical grade, purified anhydrous lanolin (derived from wool fat). The nipples should be patted dry prior to application of a small amount of lanolin.
Engorgement is a common condition that occurs as blood and lymphatic flow to the breasts greatly increases, leading to congestion and discomfort. The pain associated with engorgement can range from mild to severe. Engorgement typically occurs on the first full day of milk production and lasts only about 24 hours. The breasts may feel firm and hot to the touch and the skin may appear reddened. As with other conditions, the best remedy is prevention. Many health professionals believe frequent breast-feeding (at least every three hours) will successfully prevent engorgement. This is probably true for most women. However, the physical changes associated with initiation of breast-feeding may eventually lead to engorgement in some women. If engorgement occurs, the best remedy is to breast-feed frequently. This can relieve the engorgement and prevent the condition from worsening.
Doctors often recommend additional options for women with engorgement. A well-fitted bra can relieve some of the discomfort of engorgement. Applications of moist heat may encourage flow of milk from the breasts. Women may apply hot packs to the breasts just prior to breast-feeding. Other suggestions include frequent warm showers or alternating hot and cold showers. Cold packs applied to the breasts after breast-feeding can provide a slight pain-relieving effect.
Some infants will have a difficult time correctly latching on to an engorged breast. This can lead to inadequate nourishment and sore nipples. Expressing some excess milk, manually or with a pump, just prior to breast-feeding may relieve this difficulty. Women may also express milk after the infant has finished feeding to relieve any remaining sense of fullness. Massaging the breasts while breast-feeding may encourage milk flow from all the milk ducts and help to relieve engorgement.
Mastitis is inflammation of the breast that is frequently caused by an infection. The infected breast may feel hot and swollen. The breast may be tender to the touch, and fever, fatigue, chills, headache, and nausea may be present. Some women feel as though they have the flu. A breast infection requires prompt medical attention. Complete bed rest is important for a speedy recovery, and antibiotics are frequently prescribed. In addition, doctors often provide further guidelines for treating mastitis.
A woman should continue breast-feeding from both breasts; the milk from the infected breast is still good for the baby. Moist heat over the painful breast can be helpful, and cold applications after breast-feeding can help alleviate swelling and pain. Breast-feeding women should also avoid constricting or under-wire bras that may irritate the infected breast.
Who can breast-feed?
Breast-feeding is the best food for babies, and most mothers will be able to breast-feed their infants. However, there are some uncommon situations in which breast-feeding is not in the best interest of the infant.
Galactosemia is a rare metabolic condition that leads to an inability to break down galactose, one of the components of milk sugar (lactose). Infants with galactosemia should not breast-feed, but should be fed a special formula without lactose.60
Phenylketonuria (PKU) is another rare metabolic disorder, in which a newborn is unable to break down the amino acid phenylalanine. The resulting build-up of phenylalanine in the system can be harmful. There is some disagreement regarding whether it is safe to breast-feed infants with PKU. Some sources recommend against breast-feeding the infant with PKU.61 However, breast milk is low in phenylalanine and there is evidence that the exclusively breast-fed infant with PKU will not have damaging levels of phenylalanine accumulate in the bloodstream. A mother interested in breast-feeding her infant with PKU should work closely with a doctor. Close monitoring of the infant's blood phenylalanine levels will be necessary.62
For infants in the United States and other developed countries born to mothers infected with the human immunodeficiency virus (HIV) it may be safer not to breast-feed.63 However, there is controversy over this issue. Some researchers have found HIV in human milk, indicating that there is the potential for passing the virus to a healthy baby while breast-feeding. Other studies indicate a very low risk of actually passing the infection to the baby through the breast milk.64
Additionally, a mother with untreated active tuberculosis should not breast-feed her infant. And the infant whose mother abuses drugs should not be breast-fed.65
Healthy Lifestyle Tips
It is best to avoid all unnecessary medications, herbs, and nutritional supplements when breast-feeding. Most prescribed and over-the-counter medications, when taken by a breast-feeding mother, are considered safe for the infant. However, a doctor should always be consulted before any medication is taken. There are a few medications that mothers may need to take that may make it necessary to interrupt breast-feeding temporarily.
Caffeine, which is considered a drug, is excreted into breast milk. It is estimated that an infant receives 1.5 to 3.1 mg of caffeine after the mother drinks a cup of coffee (a cup of coffee typically contains 60 to 50 mg of caffeine). Because this amount is fairly low, a morning cup of coffee is not likely to cause any problems. However, if the mother is a heavy caffeine user, caffeine can accumulate in the infant.66 Infants have immature livers that are unable to adequately process caffeine. A baby who is irritable and sleeping poorly may be reacting to caffeine in the mother's diet. A woman can switch to decaffeinated coffees and teas to effectively reduce the amount of caffeine her baby receives through her milk.
Alcohol reaches maternal milk in concentrations similar to those in the mother's blood.67 It is therefore best for breast-feeding mothers to minimize or eliminate alcohol consumption. It is commonly believed that drinking beer can increase a woman's milk supply. In fact, drinking beer intake does increase secretion of prolactin (the hormone that stimulates production of breast milk) in both men and women.68 However, research has shown that infants breast-fed after their mothers drank alcoholic beer consumed less milk than when their mothers drank non-alcoholic beer.69
Breast-feeding mothers should not smoke. Nicotine passes to the baby through the breast milk and can cause feeding problems and illness, especially in newborns. Babies should also be protected from the dangers of second-hand smoke. Second-hand smoke has been shown to increase the risk of SIDS (sudden infant death syndrome)70, 71, 72, 73, 74 and colic in newborns.75
Initiating the breast-feeding relationship
There are many reasons why women decide not to breast-feed or discontinue breast-feeding earlier than the recommended six months. These include a lack of family, societal, or medical support;76 misinformation or lack of education about breast-feeding;77 marketing of commercial formulas to new mothers;78 and the difficulties often encountered in returning to work or school.79 In addition, there are some common difficulties that could interfere with a healthy breast-feeding relationship. These include fear of not having enough milk to nourish the baby, sore nipples, engorgement, and mastitis (inflammation of the breast, frequently caused by infection).
A new mother should try to breast-feed her baby as soon as possible after delivery, ideally within the first hour of life.80 An infant should be fed on demand. A hungry infant will first get fussy, with increased activity and rooting (a reflex wherein the infant appears to be searching for the breast with his or her mouth) or mouthing behavior. Crying is a late sign of hunger. To get into the habit of feeding their babies, new mothers are often instructed to follow a schedule of breast-feeding every four hours around the clock. However, these imposed schedules, if followed beyond the first few weeks of life, often lead to frustration and confusion. The only infant who needs to be breast-fed on such a schedule is the infant who does not demand to be fed. Feeding on demand is the best way to increase milk supply. Most infants will empty the breast in 10 to 15 minutes. Some doctors advise gradually increasing the duration of breast-feeding over the first week of life. If this regimen is followed, it is important to breast-feed for at least five minutes on each side to get the benefit of the let-down reflex (which promotes the release of milk from the storage ducts in the breasts).81
Infants need no additional foods or liquids, if exclusively breast-feeding. Early introduction of these items may make successful breast-feeding difficult. Most breast-fed infants will not require any supplemental vitamins or minerals to meet daily requirements until at least six months of age.82Vitamin D may be required for infants whose mothers are vitamin D-deficient or those infants not exposed to adequate sunlight. Iron may be required for infants with low iron stores or anemia.83
Anxiety over milk supply
Breast milk is made on demand. The more often a baby feeds, the more milk will be produced. If breast-feeding sessions are frequent and long enough, the milk supply will rarely be inadequate. Parents can be reassured that their infants are receiving enough milk if they have six or more wet diapers a day while exclusively breast-feeding. If a parent still feels anxious about the adequacy of the nourishment provided by breast-feeding alone, weekly weighing may allay fears. A weight gain of 0.38 pound (190 grams) per week is evidence of sufficient nourishment and growth.
Some low-birth-weight infants will require intensive care and ventilation in the hospital. Mothers of these infants often have difficulty continuing to produce breast milk. These mothers must rely on expressing breast milk manually because their babies cannot effectively breast-feed. Pumping milk is much less efficient than breast-feeding. Due to the inadequacy of pumping milk, milk production can decline. In low-birth-weight infants in an intensive care setting, skin-to-skin holding over a four-week period postpartum has increased a mother's milk supply.84 In contrast, women who did not participate in skin-to-skin holding of their low-birth-weight infants did not experience an increase in milk production. These findings may have implications for all mothers experiencing a diminishing milk supply. In addition, some doctors will prescribe a day of rest to busy mothers whose milk supply seems to be lessening.85 Spending a day in close and relaxed contact with one's newborn, with its associated increase in frequency of feedings, can effectively increasing milk supply.
Stress and fatigue can greatly inhibit the let-down reflex, lessening the production of milk. In a clinical trial involving mothers of premature infants, mothers who listened to an audiocassette tape based on relaxation and imagery techniques increased milk production by more than 60%, compared with mothers not listening to the tape.86 Whether relaxation techniques would increase milk supply in the mothers of full-term infants is not known.
The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.
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