Are there any substitutes to breast milk? Many times women don’t lactate and the breast milk is insufficient for the baby in that case what should be the protocol?
Hydration is an integral part of breast milk production, so the first step towards successful breastfeeding is hydrating the mother well. Initially, there is very little secretion of milk, so we try to hydrate the mother sufficiently so that enough breast milk is expressed.
There are three “B’s” to a mother – the Brain, the Breast and the Baby. Once the baby starts suckling, the brain will transmit signals and that, in turn, will help in secretion of milk. To help the mother lactate we encourage intake of food items like dalia, milk, bread etc. Galactagogue, a natural or pharmaceutical substance that enhances breast milk supply is given to the mother if the nursing needs of the baby are not being met. Commercial dietary supplements are also available in the market that help the mother in lactation.
However, if despite all efforts, the mother is still unable to produce enough breast milk, the baby can be fed commercially produced formula milk to supplement the gap in breast milk supply.
Do breast pumps help?
In case the mother has an issue with breastfeeding, like structuring or inverted nipples, a breast pump can be used to the express the breast milk and then fed to the baby using a small spoon or the traditional funneled spoon.
How long should a baby ideally be breastfed?
Exclusive breastfeeding is mandatory for six months but it can be continued from six months onwards up to two years of age along with complementary feeding.
So till six months a baby should be exclusively breastfed?
Yes. Exclusive means not even a drop of water. The baby should have the mother’s milk only.
Do you think is it possible for a mother to lactate for two years?
Absolutely, but the nutritive value and volume of milk production decrease after six to eight months. The milk becomes thinner and the constituent nutrients are much less, but breastfeeding should be continued as long as possible to keep nurturing the emotional bond between mother and child.
Some babies are lactose intolerant. What is it and why are babies lactose intolerant? How does the mother know that the baby is lactose intolerant?
A baby can be born with lactose intolerance and there is nothing much that can be done to treat the condition. In case of primary intolerance, it is basically due to lack of secretion of the enzyme required to digest lactose. As such the baby will not be able to take in the mother’s milk. The symptoms of lactose intolerance are the baby being irritable and colicky most of the time, not gaining weight satisfactorily and the abdomen appearing to be bloated. The anal region will have redness and the stools will be frequent, explosive and watery. In such a case, the mother’s milk will have to be substituted with lactose-free milk available in the market.
In this case, will the child be not deprived of the nutrients?
In case of primary intolerance, the baby’s system does not produce the enzyme required to digest the lactose, so soya milk or hydrolised milk, which contain enough protein to meet the nutritional requirement, is given to the baby. Secondary lactose intolerance happens when babies have gastroenteritis or loose motions. We have these things called brush borders cells lining the intestine; if those are damaged due to any reason, we advice that the baby is not given breast milk for a week or so. Breast milk can be reintroduced after a milk challenge.
What if the child cannot latch on to the breast?
This can be due to many reasons. Inverted nipples of mother is one cause. We advice syringing initially. If the baby cannot latch on at all, then the mother has to express the breast milk.
How is expressed breast milk different from normal breast milk?
When a mother expresses breast milk, there are chances of passing an infection to the baby through the various medium of feeding used. There are also chances of the hind milk, which is the last milk, not being expressed. When the baby sucks the breast very well and exhausts the whole breast then the hindmilk reaches the baby. Hind milk is very important for satiety of the baby. One cannot be sure of the baby getting hindmilk when feeding expressed breast milk.
How does the eating habits of the mother affect the breast milk?
Alcohol or smoking habit, even anxiety or depression of the mother eager to feed her baby make a difference to the breast milk supply. As I mentioned earlier, there are “3-Bs” to a lactating mother. If the mind is not in a calm environment or if she is agitated for some reason, it affects the milk supply. The mother has to be properly informed about the techniques of breastfeeding. A mother may feed the baby for just 5 minutes, in which case the baby will be deprived of the hind milk and consequently not feel satiated. In case the baby falls asleep while feeding, the baby’s ears have to be gently tickled to wake the baby up enough to resume sucking.
A mother consuming alcohol while breastfeeding will get dehydrated, and that will affect her breast milk supply.
Are there any diseases that can be passed on to the baby through the mother’s milk?
There are few diseases that can be passed on to the baby through breast milk, like Hepatitis B, C or HIV. But in India where the infant mortality rate is higher due to malnutrition rather than due to HIV, we recommend that the mothers continue with breastfeeding. In case of Hepatitis B, we perform certain tests and if test results are not alarming, we advise that breastfeeding be continued.