Breastfeeding is the Gold Standard of infant nutrition. Given the indisputable evidence of advantages for the mother, child, and community health in general, all health professionals should promote, and support it by taking a strong and clear position in favour of breastfeeding.
It is recommended that, except in rare individual circumstances which may be unfavourable, all children should be feed exclusively with breast milk for a period never less than six months that may be extended after the start of food diversification until 24 months of age.
Recent studies show that exclusive breastfeeding during a period of 6 months is associated with less infections with a less severe level during the first 12 months of life.

Multiple international organizations including WHO and UNICEF recommend a goal for the health programme in 2010 that 50% of infants worldwide would exclusively be breastfeed during the first 6 months of age and 25% during 12 months.

In 1990 WHO and UNICEF, launched the challenge called “The Friend’s Baby Hospital” in order to promote breastfeeding worldwide. To achieve this accreditation it has been established a set of measures called “Ten Steps to Succeed in Breastfeeding”. To be approved each hospital must achieve a rate of 80% of the overall criteria established for each step. In Portugal, the first hospital to be approved was Hospital Garcia de Orta, at Almada, in 2000. Since then many other hospitals have been approved.

Hospital de Santa Maria-CHLN is presently preparing its application to be approved by the referred international programme, which is considered as a quality certificate of health care services to the community.

Although natural, breastfeeding must be learned and promoted by health care professionals.

So, decision about breastfeeding should be done on a conscious and well reasoned basis, due to its importance.

The decision about breastfeeding should be properly supported and well planned in order to avoid some problems that may happen.
Breast milk is a living food, plain and natural, with benefits for the baby and mother, giving socio-economic benefits to the community.

Advantages of breast milk for the child are nutritional, anti-infectious, immune and cognitive.

Several studies show a higher intelligence quotient in children who have been breastfed. It also has an important role in language development due to stimulation of facial muscles.

Breastfeeding provides significant social and economic benefits by having people living on a better health basis. Related costs due to the increase in calories given to the mother mean 50% of the amount spent in purchasing artificial milk.

The non-use of non-biodegradable products nipples, bottles, milk cans, etc, also protects the planet.

There are very few contraindications on breastfeeding, only on newborn with metabolic disease, or due to maternal causes as drug addiction, HIV infection, active untreated tuberculosis, treatment with anticancer drugs, immunosuppressants, and drugs with new action and use absolutely unknown to the mother.

Hepatitis B or C, maternal fever, hyperbilirubinaemia breastfeeding and cleft palate are not considered as contraindications.

It is crucial that the mother has empathy with the baby and feel confident in her ability to breastfeed.

Pleasant feelings like having fun with her baby, touch him, look at him or even hear him promote the ejection of milk. Unpleasant feelings such as pain during breastfeeding, doubts, insecurities or stress inhibit this reflex.

The confidence and pleasure during lactation are critical to the production and ejection of milk.

To make this process in a harmonious way is vital to have a good fit between the baby’s mouth and the breast.

There are three main reflections of the baby for breastfeeding: rooting reflex and grasping, sucking reflex and swallowing reflex.

These reflexes are automatic and do not have to be learned by the baby.

The success of breast-feeding does not mean only a good fit between the breast and the baby’s mouth, but also to breastfeed in a free time concept, or whenever the baby wants. In general the frequency of feedings varies from 8 to 10 feedings per day on the first four week s to 7-9 feedings a day after the 1st month.

Until the establishment of lactation (4-6 weeks old) there should be an interval of more than three hours during both day and night.
Also, the duration depends on the effectiveness of breastfeeding in general it takes about 10 to 15 minutes post partum and after the first month, most babies feel satisfied after a 8 to 10 minutes breastfeed.

The more the baby nurses, the more milk is produced

A proper assessment of the effectiveness of breastfeeding is essential for growth and development of the baby preventing situations of insufficient intake leading to dehydration and malnutrition which in severe cases can lead to hospitalization.
It is a clinical assessment based on breastfeeding history and elimination pattern, physical examination including signs of dehydration and jaundice; physical examination of mother’s breasts, observation of feeding (sucking pattern).
Graça Oliveira
Neonatology Service – Children and Family’s Department HSM-CHLN
oligraca@hotmail.com

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Bibliography

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2 Branco AS., Bastardo C., Albuquerque M., Oliveira G. Aleitamento materno: A prática e o e o sucesso das medidas de implementação do aleitamento materno até aos 6 meses de vida. Acta Pediatra. Porá., 2004; Nº5/6; Vol.35:441-445.
3 Poling G., Lathe C. Breastfeeding: The Essential Principles. Paediatrics in Review Vol.27 No.11 November 2006 409-417.
4 Garner LM., Morton J., Lawrence RA., et al. Breastfeeding and the use of human milk. Paediatrics 2005; 115:496.