Breast milk benefits infants and mothers significantly – Neonatologist | Sunday Observer
Formulae milk increases risk of obesity and NCDs - Lancet, 2016, UNICEF, 2012

Breast milk benefits infants and mothers significantly – Neonatologist

30 July, 2022
How to hold your baby (Positioning): Head and neck in a straight line; Supporting nape of neck; Baby turned towards mother
How to hold your baby (Positioning): Head and neck in a straight line; Supporting nape of neck; Baby turned towards mother

Starting from tomorrow (August 1) a National Breastfeeding Week organised by the World Alliance for Breastfeeding Action (WABA) will bring together all levels of society to help support working mothers to breastfeed their infants for optimum health benefits. The theme (Step up-Educate, Support’) for this year is particularly appropriate for breast feeding Sri Lankan working mothers currently facing several problems due to the present economic crisis and fuel shortages countrywide.

Eminent Neonatologist from the University of Colombo in charge of the University Neonatal Unit at De Soysa Hospital for Women, Borella, Dr Nishani Lucas urges them to continue breast feeding from the time of delivery to the first six months of birth and continue as long as possible, arguing that breast milk is baby’s best source of nutrition and a start to a healthy life.


Q: Working women in Sri Lanka are currently facing several challenges following the economic crisis with recent studies showing that even the practise of breast feeding which had reached high levels a few months ago , is now showing signs of waning. Do you agree?

A. No. We began to feel the impact of the current economic crisis only a few months ago, for which Sri Lankan data is not available yet. However, along with the economic crisis, ‘work from home’ became an option for many women where it was not an option earlier both in the state as well as in the private sector which served to support breastfeeding. Also, many pregnant as well as mothers of young children were granted paid leave from the time of a positive pregnancy test till the child was at least 1 year or were allocated to stations near their home during the Covid- 19 pandemic as well as during the current economic crisis, which also served to support breastfeeding.

Q: Fear of losing their jobs , lack of support from the immediate family are some of the reasons mothers cite for switching to formula milk early. Your comments?

A. Almost all babies born at state hospitals are exclusively breastfed at the time of discharge. Although all women are entitled to 84 days of paid maternity leave, the temptation to start formula milk comes later after going home when faced with challenges with breastfeeding.

Q: Many young mothers are still unaware of the immense benefits of breastfeeding vis a vis the negative effects of formula feeding. Tell us how feeding a newborn artificial formulae can negatively impact the child’s growth .

A. The many negative impacts of artificial formulae milk on a newborn include the following: Formula milk is not sterile and contains many microorganisms, eg. Enterobacter sakazakii that is responsible for neonatal meningitis. The child misses out on the benefits of breastfeeding. Formula feeding decreases brain development, lowers immunity and increases risk of malocclusion, respiratory infection, diarrhoea, ear infection, sudden infant death, leukemia, asthma, allergy and eczema. Lancet, 2016, UNICEF, 2012 which I have just quoted in the list above, also mentions higher risk of obesity, diabetes, heart disease, hypertension in formula fed children among other diseases in adulthood.

Q: According to new evidence following island wide awareness raising programmes by the Ministry of Health and pro-breastfeeding NGO’s , more working mothers now want to breastfeed their babies to full term. At the same time, many new mothers have expressed uncertainties and worries concerning basic techniques on breast feeding and whether the baby has had enough milk in the first few days of its birth. What are the signs they should they look for?

A. The most reliable sign is the amount of weight loss in the first few days followed by adequate weight gain after 2 weeks of age (10-30g/day). Baby should regain the birth weight within the first 2 weeks. The weight loss on the first day or 2 should be less than 5% from the birth weight. For example, a baby with birth weight of 3kg, if weight in 24 hours is 2.95kg, weight loss is 50g and weight loss percentage = 50/3000 ~ 1%, which is less than 5% and indicates that baby has received adequate milk (as breast milk is the sole oral intake of the baby).. A mother with a good technique is likely to have a baby with minimal weight loss, while a mother with a baby with weight loss more than 5% on the first / second day will be supported to breastfeed by modifying the technique / improving her confidence.

Q: If the baby falls asleep while feeding, how will a mother know if he/she has had sufficient milk?

A. Most babies fall asleep when their stomach is full. The mother will feel that the breast is empty and light at the end of the feed compared to full breasts felt at the beginning of the feed. Sufficiency of milk is determined by percentage weight loss as described above.

Q: Does the breast size of the mother matter in giving the baby better quality and more milk?

A. No. The ability to produce milk is not related to breast size. Breast size depends on how much fat is stored in the breast.

Q: Does the duration of feeding vary from the first few hours of birth and become less or more as the baby grows?

A. The duration of feed tends to decrease with time, as both the baby and the mother master the skill of breastfeeding. A feed which lasted for 10-15 minutes soon after birth may be shortened to 5 minutes or less by 2-3 months of age.

Q: Another worrying problem among new mothers is how they should hold the baby while nursing . What is the correct position?

A. They should ensure that the baby’s head and neck are aligned and in a straight line where the baby is completely turned towards the mother. The baby’s head should not be pressed towards the breast. Instead, the head should be supported, by keeping two fingers at the nape of the neck.

Q: Most newborns have wind problems while feeding and crying. Is it normal for newborns to pass wind? How and when should a mother burp her newborn?

A. Wind problems are common in newborns as they tend to swallow air while they are breastfeeding. Good attachment, where most of the areola is inside the baby’s mouth (which should be wide open) would minimize air swallowing. Keeping the baby in a prone position (tummy down) soon after a breastfeed and gently pressing on the back will help to release the swallowed air. This is the most effective position to burp the baby. Baby should be burped for 15-20 minutes after each feed.

Q: Can the father also burp the baby?

A. Yes of course. Holding the baby upright in the carrying position is effective only when done by a male (father) as the baby’s stomach is pressed against the rib cage which is a hard surface. It is not effective when done by a female (mother) due to the baby’s stomach pressing on the breast tissue which is a soft surface that does not compress the baby’s stomach sufficiently to release air.

Q: Will the diet of a nursing mother such as eating high fibre foods cause gas in newborns ?

A. No. The mother can eat or drink anything she likes except alcohol, smoking and street drugs.

Q: They also want to know if their normal diet is sufficient to produce better quality and more milk for the baby. Or if they need something special especially if the mother is malnourished?

A. A normal balanced diet is enough. Good hydration helps. The mother should drink plenty of water. The answer to your second question is No. Even if the mother is malnourished milk volume and quality is not affected other than in severe malnutrition

Q: What about vitamin and mineral supplementation to replenish her supplies used up for lactation?

A. Yes. She needs to take the calcium and iron supplements prescribed by her doctor.

Q: Can a working mother express her own milk and store it in the fridge till she returns from work? How? For how long?

A. Certainly. It is better to start expressing breastmilk at least 2 weeks before planning to return to work as it would help to build a stock. Expressed breast milk should be given via cup to the baby. They should be stored in the same container that is used to feed the baby to minimise contamination. Bottles should not be used as they introduce infection as well as cause ‘suck confusion’. Cups which can be securely closed can be stored in the refrigerator freezer with a separate door for 3 months, without a separate door for 2 weeks and in the lower refrigerator compartment for 24 hours. Milk should be thawed by keeping the cup in warm water and thawed milk should not be refreezed. Expressed breastmilk can be kept at room temperature for 6 hours.

Q: Many myths and superstitions are currently swirling around breast feeding .To cite a few: women with too small breasts lack the capacity to breastfeed: Breastfeeding causes the breast to sag: Certain foods should be avoided when breastfeeding. What is your opinion on such myths?

A. Breast size is determined by the amount of fat in the breast. Breast milk is produced by alveoli lined by lactocytes which have no relationship with the breast size. Breast size has no bearing with the capacity to breastfeed. In fact, it is easier to feed with a small breast compared to difficulties faced with a large breast, for which more skilled support is required.

Q: Are there any gaps in the promotion of breastfeeding that you would like to see filled?

A. At the present time I feel mothers will try harder to make breastfeeding work before self-prescribing formula milk to their child, owing to the recent price hikes of all commodities including formula milk, on the same or reduced income.

However, the fuel crisis may make it harder for midwives to complete their home visits as well as mothers to come to the MOH clinic or Lactation Management Centre to obtain skilled support for lactation, which may turn more mothers towards self-prescribing formula milk to their child.

Q: So what will be the impact on the country’s economy?

A. Failure to breastfeed costs the global economy US$302 billion every year (Lancet 2016). So promoting breastfeeding would be a step in the right direction, in addition to resolving the economic crisis as well.

Q: As a message to new mothers what advice can you give on the importance of breastfeeding and its benefits?

A. Breastmilk is something only YOU can give to your child, to help shape his / her whole life. Embrace this opportunity and ensure that you give your child a good start in life. Every mother can do it. Seek help from the nearest lactation management centre in case you face any difficulty with breastfeeding.