Information on Breastfeeding

Breast is best… This is the ultimate slogan for every mother that is capable of producing this amazing substance. Breastmilk is not just another milk; it contains hundreds of useful substances including water, nutrients, trace elements and vitamins, antibacterial and other antimicrobial substances, pro- and prebiotics, diverse growth factors and modulators, anti-inflammatory and anti-cancer substances, digestive enzymes, hormones, transport proteins and many more. The composition of breastmilk changes over time beginning with the very rich colostrum for the first 3 days changing over to the mature milk after about 2 weeks. It also changes according to seasons, breastfeeding pattern and according to the number of pregnancies. It even changes according to the daytime of the feed and during a feed itself (foremilk versus hindmilk). One could say it adapts to the needs of the infant.

Breastmilk on the other hand can also harbor harmful substances such as viruses, (e.g. HIV in an infected and not well controlled mother) medicines and toxins. Most prescribed medicines are not excreted in the breastmilk in sufficient doses to be harmful to the infant, including antibiotics. The very few exceptions to this rule of safety of medications include if you are on certain cancer drugs or mood stabilizers like lithium. In these cases breastfeeding is not in the best interest of your child. For further information on which medications should be avoided while breastfeeding and what alternatives are available, ask your healthcare provider.

HIV infection of the mother is not usually a reason not to breastfeed, however this needs to be discussed preferably prior to delivery with your healthcare provider. An involvement of a paediatrician prior to delivery in these cases is recommended.

Benefits of breastfeeding:

Breastfed infants in comparison to formula fed infants experience less infectious episodes, like gastroenteritis, ear and chest infections. Furthermore breastfed children have a moderate improvement of their neurodevelopment including cognitive, motor and visual function up to the 8th year of life. The degree of neurodevelopmental advantage is directly related to the duration of breastfeeding. Also, the longterm risk of obesity and the so-called metabolic syndrome (overweight, Type 2 diabetes, high blood pressure, heart disease, strokes) is reduced.

Another big benefit of breastfeeding is the reduction in allergy risk. If a parent has allergic diseases the offspring has at least a chance of 50% of developing an allergy. In breastfed infants this rate is reduced. The exact mechanism for this is unknown, but likely attributable to many of the useful substances present in breastmilk.

Breastfeeding provides also benefits to the mother such as natural birth control (98% safe within the first 6 months of exclusive breastfeeding) and reduction in ovarian and breast cancer, type 2 diabetes and postnatal depression.

Risks of breastfeeding:

Apart from the mentioned infectious risk, breastmilk has little iron and vitamin D contents. This however is usually not a problem for the first 4-6 months of life, as the level of absorption of these components is much higher than in the average infant formula or supplementation product. It is however recommended to expose the infant to short periods of direct sunshine every day, especially in areas with little daily sunshine times, to boost the body’s own vitamin D production. The iron intake is usually sufficient unless the infant was born severely premature, in which case extra supplementation is needed. After the age of 6 months additional intake of calories and nutrients is needed as the breastmilk caloric supply becomes too little for the growing infant.

Very rarely in susceptible infants proteins from the maternal diet may sensitize an infant and lead to severe allergic reactions on first exposure to the protein source (e.g. cows milk, peanuts, etc.) In general, a mother should not avoid any food groups unless the infant reacts severely to traces of certain proteins in the breastmilk (extremely rare).

Duration of breastfeeding:

WHO recommends exclusive breastfeeding until the age of 6 months followed by breastfeeding in addition to other foods “until the age of 2 years or beyond”. This is based on the fact that breastfeeding provides adequate nutrition in addition to supplemental foods as well as protection from environmental threats such as infections. This applies especially to the poorer areas of the world and WHO estimates that alone with this practice about 800,000 children can be saved per year. In a well-resourced setting the infant can start adding other foods when they show interest in foods and have enough strength to sit up with support, from as early as 3-4 months of age.

In today’s society many interests and obligations clash with the plan to breastfeed for a prolonged period, such as having to return to work early, reduction in milk production due to the stresses at the work place, challenges surrounding expressing breastmilk at work and in general, public perception of breastfeeding in public areas, etc. Many of these factors can be addressed to make breastfeeding or feeding of breastmilk despite these challenges available. Talk to your healthcare provider to address worries and issues before or when they arise and to look for solutions.

In short:
Breastfeeding is the best choice for child and mother if it is available. There are only a few rare occasions when breastfeeding is not recommended and these should be discussed with your healthcare provider if there are any concerns. The recommended duration by WHO is 6 months exclusively and then continued for 2 years or more if possible.