Breastfeeding provides numerous benefits for mothers and their children. However, currently, only 40% of the global average rate of infants below six months of age was exclusively breastfed, with only 23 countries managed to achieve rates of 60% or higher. World Health Organization (WHO) Global Nutrition Targets 2025 has set targets to achieve at least 50% rate of exclusive breastfeeding among members’ countries. The National Plan of Action for Nutrition of Malaysia III (NPANM III), 2016-2025 has set another indicator to achieve at least 70% of infants below 6 months of age to be exclusively breastfed by 2025.
In Malaysia, the prevalence of exclusive breastfeeding was 19.3% in 2006 and has increased to 47.1% in 2016. Even though there was an increment, this was still less than the targeted prevalence set by WHO and NPANM III.
2. BENEFITS OF BREASTFEEDING
Benefits of Breastfeeding
Children who are breastfed experience improved dental health and neuro developmental outcomes. They have decreased risk of:
Otitis media
Diarrhoea
Respiratory tract infection
Necrotizing enterocolitis
SIDS
Atopic dermatitis
Asthma
Celiac Disease
Crohn’s Disease and ulcerative colitis
Late-onset sepsis in preterm infants
Type 1 and type 2 diabetes
Leukaemia
Childhood overweight and obesity
Maternal Benefits
There are also maternal health benefits to breastfeeding such as decreased risk of the following:
Decreased excessive menstrual blood loss
Breast, ovarian, endometrial and thyroid cancers
Hypertension
Type 2 diabetes
Rheumatoid Arthritis
Breastfeeding is also a great benefit to the environment and society. It was shown that breastfeeding families become sick less often and the parents miss work less. Breast milk will be always available, at the right temperature and ready to be fed,there is no risk of contamination, even in the case of emergency situations, such as natural disasters.
3. HOW MUCH & HOW OFTEN TO BREASTFEED
One of the most common questions new parents have is how often their baby should be fed. The best answer is surprisingly simple: in general, babies should be fed whenever they seem hungry.
Every baby is different. How much and how often your baby feeds will depend on your baby’s needs. Here are a few things to know about how much and how often babies breastfeed during the first days, weeks, and months of life.
First Days
Your newborn baby’s belly is tiny. He or she does not need a lot of milk with each feeding to be full.
Your baby may want to eat as often as every 1 to 3 hours. Frequent feeding helps increase your milk supply and gives your baby practice at sucking and swallowing.
You may be able to hear your baby sucking and swallowing the breast milk.
Most babies who are getting breast milk should not be fed infant formula in the first few days. If you are concerned about meeting your baby’s needs, talk to a lactation consultant, or your baby’s nurse or doctor, right away to find out how to address any breastfeeding problems and determine the best way to meet your baby’s needs.
First Weeks and Months
Over the first few weeks and months, the time between feedings will start to get longer— on average about every 2 to 4 hours for most exclusively breastfed babies. Some babies may feed as often as every hour at times, often called cluster feeding, or may have a longer sleep interval of 4 to 5 hours.
How often your baby feeds might change depending on the time of day. Some feeding sessions may be long, and others short. That is okay. Babies will generally take what they need at each feeding and stop eating when they are full. They should seem content and drowsy after feeding when they have had enough milk.
Your baby will breastfeed about 8 to 12 times in 24 hours.
6 to 12 Months
Breastfed babies’ feeding patterns (how often and how long they feed) vary and will likely change as they grow and start eating more solid foods.
If your baby seems to be less interested in breastfeeding after you introduce solids, try breastfeeding first before you offer solids.
Your breast milk is the most important source of nutrition, even after you start feeding your baby solids.
12 to 24 Months
The number of times a day a toddler breastfeeds varies. Some want to breastfeed only before bed or in the morning, while others continue to drink breast milk as a bigger portion of their daily diet. Continue to follow your child’s cues to decide when he or she is hungry and wants to breastfeed.
4. PROPER STORAGE & PREPARATION
Safe Storage of Expressed Breast Milk
Before expressing or handling breast milk:
Wash your hands well with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
Mothers can express breast milk by hand or with a manual or electric pump.
If using a pump, inspect the pump kit and tubing to make sure it is clean. Discard and replace mouldy tubing immediately.
If using a shared pump, clean pump dials, power switch, and countertop with a disinfectant wipe.
Storing breast milk after expressing:
Use breast milk storage bags or clean, food-grade containers to store expressed breast milk. Make sure the containers are made of glass or plastic and have tight fitting lids.
Avoid bottles with the recycle symbol number 7, which indicates that the container may be made of a BPA-containing plastic.
Never store breast milk in disposable bottle liners or plastic bags that are not intended for storing breast milk.
Freshly expressed or pumped milk can be stored:
At room temperature (77°F or colder) for up to 4 hours.
In the refrigerator for up to 4 days.
In the freezer for about 6 months is best; up to 12 months is acceptable. Although freezing keeps food safe almost indefinitely, recommended storage times are important to follow for best quality.
Storage tips:
Clearly label the breast milk with the date it was expressed.
Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.
If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it.
Safe Thawing of Breast Milk
Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
There are several ways to thaw your breast milk:
In the refrigerator overnight.
Set in a container of warm or lukewarm water.
Under lukewarm running water.
Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer.
Once breast milk is brought to room temperature or warmed, use it within 2 hours.
Never refreeze breast milk after it has thawed.
Feeding Expressed Breast Milk
Breast milk does not need to be warmed. It can be served room temperature or cold.
If you decide to warm the breast milk, here are some tips:
Keep the container sealed.
Place the sealed container into a bowl of warm water or hold it under warm, but not hot, running water for a few minutes.
Test the milk’s temperature before feeding it to your baby by putting a few drops on your wrist.
Do not heat breast milk directly on the stove or in the microwave.
Swirl the breast milk to mix the fat, which may have separated.
If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded.
5. CONTRAINDICATION
Mothers should NOT breastfeed or feed expressed breast milk to their infants if
Infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder
Mother is infected with the human immunodeficiency virus (HIV) (Note: recommendations about breastfeeding and HIV may be different in other countries)
Mother is infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2)
Mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed)
Mother has suspected or confirmed Ebola virus disease
Mothers should temporarily NOT breastfeed and should NOT feed expressed breast milk to their infants if
Mother is infected with untreated brucellosis
Mother is taking certain medications
The mother is undergoing diagnostic imaging with radiopharmaceuticals
Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission)
In conclusion, mothers may resume to breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant.
Mothers should temporarily NOT breastfeed, but CAN feed expressed breast milk if
Mother has untreated, active tuberculosis
(Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious)
Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery
In conclusion, airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection.
Are medications safe to take while breastfeeding?
Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. So, kindly consult your doctor if you have any doubts.
6. COVID-19 & BREASTFEEDING Q&A
Can COVID-19 be passed through breastfeeding?
Ans: Transmission of active COVID-19 (virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.
Should mothers breastfeed in communities where COVID-19 is prevalent?
Ans: Yes. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers.
Following delivery, should a baby still be immediately placed skin-to-skin and breastfed if the mother is confirmed or suspected to have COVID-19?
Ans: Yes. Immediate and continued skin-to-skin care, including kangaroo mother care, improves the temperature control of newborns and is associated with improved survival among newborn babies. Placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces mortality.
The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.
Can women with confirmed or suspected COVID-19 breastfed?
Ans: Yes. Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should:
Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby
Wear a medical mask during any contact with the baby, including while feeding
Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again
Routinely clean and disinfect surfaces that mothers have touched.
It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.
If a mother confirmed or suspected to have COVID-19 does not have a medical face mask should she still breastfeed?
Ans: Yes. Breastfeeding unquestionably reduces mortality in newborns and infants and provides numerous lifelong health and brain development advantages to the child.
Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. Mothers should follow other infection prevention measures, such as washing hands, cleaning surfaces, sneezing or coughing into a tissue.
If a mother has confirmed or suspected COVID-19 and is too unwell to breastfeed her baby directly. What can she do?
Ans: If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you. This could include:
Expressing milk
Donor human milk.
If expressing breast milk or donor human milk are not feasible then consider wet nursing (another woman breastfeeds the child) or infant formula milk with measures to ensure that it is feasible, correctly prepared, safe and sustainable.
If a mother had confirmed or suspected COVID-19 and was unable to breastfeed, when can she start to breastfeed again?
Ans: You can start to breastfeed when you feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19. There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother. Health workers or breastfeeding counsellors should support you to relactate.
If a mother has confirmed or suspected COVID-19, is it safer to give her baby infant formula milk?
Ans: No. There are always risks associated with giving infant formula milk to newborns and infants in all settings. The risks associated with giving infant formula milk are increased whenever home and community conditions are compromised, such as reduced access to health services if a baby becomes unwell, reduced access to clean water and/or access to supplies of infant formula milk are difficult or not guaranteed, affordable and sustainable.
The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.
Can a breastfeeding woman get vaccinated against COVID-19?
Ans: Yes, women who are breastfeeding can take the vaccine when it becomes available to them.
None of the currently approved vaccines use the live virus, so there is no risk of passing the virus to the baby through breastmilk.
There is also some evidence that, after vaccination, antibodies are found in breastmilk, which may help protect the baby against COVID-19.
7. SUPPLEMENTS FOR BREASTFEEDING MOTHER
Supplements for breastfeeding mothers:
1. Omega-3 fatty acids
Omega-3 fatty acids are essential to support baby’s brain, eye, immune system and nervous system development. Studies also show that maternal supplementation of omega-3 fatty acids during breastfeeding can reduce food allergies and eczema in baby.
2. Calcium and vitamin D
The recommended daily intake of calcium for breastfeeding women is 1200mg/day while an estimated of 600IU (15mcg) of vitamin D is required. Calcium is vital for the bone and teeth formation of baby while vitamin D is needed for calcium absorption.
3. Iodine
Babies require iodine for proper growth, development of brain, visual motor skills and hearing. Since breastfed babies depend on breast milk alone as their source of iodine, breastfeeding mothers need to get enough iodine for the baby and themselves. It is recommended that breastfeeding mothers take an iodine supplement of 150mcg per day.
Vitamins B group is important for the nervous system development and production of red blood cells. Since they are water-soluble and our bodies do not store them, daily supplementation is needed. These vitamins are mostly obtained from animal food sources and not found in plant-based food. Therefore, it is also crucial for breastfeeding mothers who are vegetarian to take supplements containing vitamin B group.
5. Fenugreek
Fenugreek is a herb that is commonly used as a galactagogue to increase breast milk production. Studies indicate that fenugreek may have mild galactagogue effect.Fenugreek can be taken in the form of capsules, powder mixed with drinks or tea, typically in doses of 1-6g daily. It is considered safe in nursing mothers but should be used with caution in people with diabetes as it can lower blood sugar if taken at higher doses.
Although not considered harmful when used in moderation, fenugreek can cause your breastmilk, sweat, and urine to smell like maple syrup. Your baby’s urine and sweat may start to smell like maple syrup, too. Note that the latter should not be confused with maple syrup urine disease.
6. Lecithin
Lecithin is a phospholipid elements. It’s thought to help prevent the breast ducts from getting plugged by increasing the polyunsaturated fatty acids in the milk and decreasing its stickiness. A plugged duct occurs when the milk passageways in the breast become blocked.Reference:
Farahana Mohamad Pilus, Norliza Ahmad, Nor Afiah Mohd Zulkefli. 2019. Predictors of Exclusive Breastfeeding Among Mothers Attending Rural Health Clinics in Hulu Langat District. Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346). Mal J Med Health Sci 15(SP3): 15-21.American Academy of Pediatrics. 2021. Breastfeeding Overview.
Sanjeev Jain, MD, FAAP. 2020. How Often and How Much Should Your Baby Eat? American Academy of Pediatrics.
Centre of Disease Control and Prevention. 2020. Nutrition: How Much and How Often to Breastfeed.
Centers of Disease Control and Prevention. 2021. Breastfeeding: Proper Storage and Preparation of Breast Milk.
American Academy of Pediatrics. 2021. Breastfeeding Overview.
Centres of Disease Control and Prevention. 2019. Breastfeeding: Contraindication.
World Health Organization. 2020. Coronavirus disease (COVID-19): Breastfeeding Q&A.
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