Breastfeeding

An infant breastfeeding
International Breastfeeding Symbol

Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts, not from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is possible for most mothers to nourish their infant (or infants in the case of twins and multiple births) by breastfeeding for the first six months, if not longer, without the supplement of infant formula milk or solid food.

In most situations human breast milk is the best source of nourishment for human infants,[1] preventing disease, promoting health and reducing health care costs[2] (exceptions include situations where the mother is taking certain drugs or is infected with tuberculosis or HIV). Experts disagree about how long to breastfeed to gain the greatest benefit, and about the risks of using artificial formulas.[3][4][5] In both developing and developed countries, artificial feeding is associated with more deaths from diarrhoea in infants.[6]

The World Health Organization (WHO) recommends breastfeeding for up to two years or beyond and exclusive breastfeeding for the first six months of life. The American Academy of Pediatrics (AAP) recommends at least one year of breastfeeding and exclusive breastfeeding for the first six months of the infant's life. Exclusive breastfeeding for the first six months of life "provides continuing protection against diarrhea and respiratory tract infection" that is more common in babies fed formula. [7] The WHO[8] and AAP[9] both stress the value of breastfeeding for mothers and children. While recognizing the superiority of breastfeeding, regulating authorities work to make artificial feeding safer when it is used.[4]

According to a WHO 2001 report,[10] alternatives to breastfeeding include:

Contents

Lactation

Main article: Lactation

The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.

Breast milk

Main article: Breast milk

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the bloodstream and bodily stores. Breastfeeding uses an average of 500 calories per day and helps the mother lose weight after giving birth [11] The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child.

"Research shows that the milk and energy content of breastmilk actually decreases after the first year.[8] Breastmilk adapts to a toddler's developing system, providing exactly the right amount of nutrition at exactly the right time.[9] In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of human milk provide these percentages of the following minimum daily requirements:

Energy 29% Folate 76% Protein 43% Vitamin B12 94% Calcium 36% Vitamin C 60%10 Vitamin A 75% "[2]

Benefits for the infant

Himba woman and child.
An African woman with her child in Kabala in 1960s.

During breastfeeding nutrients and antibodies pass to the baby[12] and the maternal bond can also be strengthened.[13] Research has demonstrated a variety of benefits to breastfeeding an infant. [14] These include:

Superior nutrition

Breast milk contains the ideal ratio of the amino acids cystine, methionine, and taurine to support development of the central and peripheral nervous system. Children aged seven and eight years old who were of low birthweight who were breastfed for more than eight months demonstrated significantly higher intelligence quotient scores than comparable children breastfed for less time, suggesting breastfeeding offers long-term cognitive benefits in some populations.[15]
The quality of a mother's breast milk may be compromised by stress, bad food habits, chronic illnesses, smoking, and drinking.[16]

Less Diarrhea

Breastfeeding protects infants against diarrhea as compared to formula-fed peers;[17] compared to formula-fed peers, death rates due to diarrhea in breastfed infants are lower irrespective of the development level of the country.[6] The WHO did a meta-analysis that presented evidence that breastfeeding in the first 6 months can protect infants from dying of diarrhea. [18]

Greater immune health

Breast milk include several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)[19][20] and immunoglobulin A protecting against microorganisms.[21]

Despite also being a factor in the transmission of HIV from mother to child, some constituents in breast milk may be protective of infection. In particular, high levels of certain polyunsaturated fatty acids in breast milk (including eicosadienoic, arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in Breast milk.[22] Due to this, in underdeveloped nations infant mortality rates are lower when HIV-positive mothers breastfeed their newborns, than when they use formula feed. Bear in mind, differences in infant mortality rates have not been reported in better resourced areas.[23] Avoidance of all breastfeeding is recommended by UNAIDS where formula feeding is acceptable, feasible, affordable and safe.[24] Treating infants prophylactically with Lamivudine can help to decrease the transmission of HIV through mother to child. [25] Breastfeeding does not appear to offer protection against allergies.[26]

Higher Intelligence

Babies with a specific variant of the FADS2 gene (approximately 90% of all babies) demonstrate an IQ an average of 7 points higher if breastfed.[27]

Long term health effects

Breastfeeding has been proven to lower the risk of asthma, protect against allergies, and provide improved protection for babies against respiratory and intestinal infections.[28]

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.[29] Breastfeeding also appears to protect against diabetes mellitus type 2,[30][31] at least in part due to its effects on the child's weight.[31]

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[32] The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.[33]

A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.[34]

A study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed. [35]

Fewer Infections

Breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months post-partum. The protection was strongest immediately after birth, and was ineffective past seven months[36] Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital.[37] Increased duration of certain types of middle ear infections (otitis media with effusion, OME) in the first two years of life is associated with a shorter period of breastfeeding, in addition to feeding while lying down and maternal cigarette smoking.[38] A reduced proportion and duration of any otitis media infection was associated with breastfeeding rather than formula feeding for the first twelve months of life.[17]

Less Atopy

In children who are at risk for atopy (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. [39] However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.[40] Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.[41]

Less necrotizing enterocolitis

Necrotizing enterocolitis (NC), found mainly in premature births, is six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, as compared to exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.[42]

Possible protection from sudden infant death syndrome

Breastfed babies have improved arousal from sleep, which may reduce the risk of sudden infant death syndrome.[43]

Benefits for mothers

Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is at best an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body.[12] and the maternal bond can be strengthened.[13] Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.[44]

Long-term Health Effects

Breastfeeding mothers have less risk of endometrial,[45][46] and ovarian cancer,[9][13] and osteoporosis.[9][13]

Mothers who breastfeed longer than eight months also benefit from bone re-mineralisation[47] and breastfeeding diabetic mothers require less insulin.[48] Breastfeeding helps stabilize maternal endometriosis,[9] reduces the risk of post-partum bleeding[49] and benefits the insulin levels for mothers with polycystic ovary syndrome.[50]

Women who breast feed for longer have a smaller chance of getting rheumatoid arthritis, suggests a Malmo University study published online ahead of print in the Annals of the Rheumatic Diseases (See Women Who Breast Feed for More than a Year Halve Their Risk of Rheumatoid Arthritis). The study also found that taking oral contraceptives, which are suspected to protect against the disease because they contain hormones that are raised in pregnancy, did not have the same effect. Simply having children but not breast feeding also did not seem to be protective.

Bonding

The hormones released during breastfeeding strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.[51] Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.[52]

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.

Hormone release

Breastfeeding releases the hormones oxytocin and prolactin which relax the mother and make her feel more nurturing toward her baby.[53] Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.[49]

Weight loss

As fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6 months—can help mothers lose weight.[54] However, weight loss is highly variable among lactating women, and diet and exercise is a more reliable way of losing weight.[55]

Natural Postpartum Infertility

Also termed Lactational amenorrhea, a fully breastfeeding woman may not ovulate, or have regular periods, for up to 6 months; although this should not be relied on as a form of contraception.[56]

Organisational endorsements

World Health Organization

“ [the] vast majority of mothers can and should breastfeed, just as vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother's milk be considered as unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative - expressed milk from the infant's own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast milk substitute fed with a cup, which is a safer method than a feeding bottle or a teat - depends on individual circumstances. [57] ”

The WHO recommends two years of breastfeeding and exclusive breastfeeding for the first six months of life.

American Academy of Pediatrics

“ Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.[9] ”

AAP recommends at least one year of breastfeeding and exclusive breastfeeding for the first six months of life.

Breastfeeding difficulties

Main article: Breastfeeding complications

Despite being a natural human activity, breastfeeding difficulties are not uncommon. Putting the baby to the breast as soon as possible after birth helps to avoid many problems. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.[9] Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.[58] There are some situations in which breastfeeding may be harmful to the infant, including infection with HIV and acute poisoning by environmental contaminants such as lead.[28] Rarely a mother may not be able to produce breastmilk due to prolactin deficiency which may be caused by Sheehan's syndrome an uncommon result of a sudden drop in blood pressure during childbirth typically due to hemorrhaging.It is also common nowadays in developed countries that many working mothers choose not to breast feed their children due to the inconveniences that occure at work. For example,mothers need to schedule for frequent pumping breaks, and find a place at work where is clean, private and quiet for pumping. These inconveniences faced by these breast feeding mothers eventually cause them to give up on breast feeding and use formulas for feeding infants instead.

Infant weight gain

Breastfed infants generally gain weight according to the following guidelines:

0–4 months: 170 grams per week†
4–6 months: 113–142 grams per week
6–12 months: 57–113 grams per week
† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.

The average breastfed baby doubles birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.[59] By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.[60];

Methods and considerations

There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche League also provide advice and support.

Early breastfeeding

In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. [61]. Early breast-feeding is associated with fewer nighttime feeding problems [62]

Time and place for breastfeeding

Breastfeeding at least every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.[9] Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day.[63] Feeding a baby "on demand" (sometimes referred to as "on cue"), means feeding when the baby shows signs of hunger; feeding this way rather than by the clock helps to maintain milk production and ensure the baby's needs for milk and comfort are being met.[8] However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hindmilk.[64].

"Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain.[3]"

"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are literally a substitute for the mother when she can't be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.[4]"

Rooming-in bassinet

Most US states now have breastfeeding laws which allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care permits the baby to stay with the mother and improves the ease of breastfeeding. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring them to go to a special area.

Latching on, feeding and positioning

Correct positioning and technique for latching on can prevent nipple soreness and allow the baby to obtain enough milk. [65] The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a breastfeeding session, then quickly moving baby onto the breast while baby's mouth is wide open. [66] In order to prevent nipple soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the baby's mouth.[65][67] To help the baby latch on well, tickle the baby's top lip with the nipple, wait until the baby's mouth opens wide, then bring the baby up towards the nipple quickly, so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat, with the baby's tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto. Resist the temptation to move towards the baby, as this can lead to poor attachment.

Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.[68]

The baby may pull away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.

While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn.

When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows.

Exclusive breastfeeding

Two 25ml samples of human breast milk. The left hand sample is Foremilk, the watery milk coming from a full breast. The right hand sample is Hindmilk, the creamy milk coming from a nearly empty breast. [69]

Exclusive breastfeeding is when an infant receives no other food or drink besides breast milk.[8] National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mixed feeding.

Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is important to recognize the baby's hunger signs. It is assumed that the baby knows how much milk it needs and it is therefore advised that the baby should dictate the number, frequency, and length of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.

While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements.[70] Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.

Expressing breast milk

Manual breast pump

When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.[71]

Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again.

"Exclusively Expressing", "Exclusively pumping" and "EPing" are terms for a mother who feeds her baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes. Kellymom [5] has a page of links relating to exclusive pumping.

It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4-6 weeks old and is good at sucking directly from the breast.[72] Because It takes less effort to suck from a bottle, a baby might lose its desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4-6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though historically the use of wet nurses was common, some women dislike the idea of feeding their own child with another woman's milk; others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.[73] The transmission of some viral diseases through breastfeeding can be prevented by expressing breast milk and subjecting it to Holder pasteurisation.[74]

Mixed feeding

Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle

Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.

Tandem breastfeeding

Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.

In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully [75][76] [77].

Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.[78]

Extended breastfeeding

Breastfeeding past two years is called extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S.[79] Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother.

Shared breastfeeding

Main article: Wet nurse

It used to be common worldwide, and still is in developing nations such as those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.[80] A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry. Shared breastfeeding can incur strong negative reactions in the Anglosphere[81]; American feminist activist Jennifer Baumgardner has written about her experiences in New York with this issue[82].

Weaning

Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned once it relies on other food for all its nutrition and it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and can drink milk - usually cow or goat milk - well beyond the age of weaning.[83]

In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this medication posed serious health risks to women, such as stroke, and the U.S. FDA withdrew this indication for the drug in 1994.[84]

Nursing Bras

A nursing bra provides the baby with easier access to the breast, but are not always necessary and certainly not required. Wearing a bra will not affect how the breast changes with pregnancy and breastfeeding, although an ill-fitting bra can cause plugged ducts or mastitis. Many women find that the size of their breasts change dramatically, necessitating a bra fitting after childbirth rather than before. When pregnant a women's breast can fluctuate one to three cup sizes an hour.

History of breastfeeding

Famille d’un Chef Camacan se préparant pour une Fête ("Family of a Camacan chief preparing for a Festival") by Jean-Baptiste Debret shows a woman breastfeeding a child in the background.
Main article: History of breastfeeding

Prior to the twentieth century, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow or goat's milk were not very positive. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this did not have a favorable outcome, either. True commercial infant formulas appeared on the market in the mid 19th Century but their use did not become widespread until after WWII. As the superior qualities of breast milk became better-established in medical literature, breastfeeding rates have increased and countries have enacted measures to protect the rights of infants and mothers to breastfeed.

Sociological factors with breastfeeding

Researchers have found several social factors that correlate with differences in initiation, frequency, and duration of breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status and other factors have been shown to affect a mother’s choice whether or not to breastfeed and how long she breastfeeds her child.
Education According to Singh, Kogan, and Lee, more mothers with higher education levels correlate breastfeed, and these mothers breastfeed for longer.
Race and culture Singh et al also found that African American women are less likely than white women of similar socioeconomic status to breastfeed and Hispanic women are more likely to breastfeed. This may be evidence that breastfeeding acceptability is based on cultural acceptance, and that acceptance is related to socioeconomic status in the mother’s culture. The Center of Disease Control used information from the National Immunization Survey to determine the proportion of Caucasian and African American children that were ever breast fed. They found that 71.5% of Caucasians had breastfed their child while only 50.1% of African Americans had. At six months of age this fell to 53.9% of Caucasian mothers and 43.2% of African American mothers who were still breastfeeding.
Income Deborah L. Dee's research found that women and children who qualify for WIC, Special Supplemental Nutrition Program for Women, Infants, and Children were among those who were least likely to initiate breastfeeding. Income level can also contribute to women discontinuing breastfeeding early. More highly educated women are more likely to have access to information regarding difficulties with breastfeeding, allowing them to continue breastfeeding through difficulty rather than weaning early. Women in higher status jobs are more likely to have access to a lactation room and suffer less social stigma from having to breastfeed or express breastmilk at work. In addition, women who are unable to take an extended leave from work following the birth of their child are less likely to continue breastfeeding when they return to work.
Other factors Other factors they found to have an effect on breastfeeding are “household composition, metropolitan/non-metropolitan residence, parental education, household income or poverty status, neighborhood safety, familial support, maternal physical activity, and household smoking status.”

See also

Footnotes

  1. ↑ Picciano M (2001). "Nutrient composition of human milk". Pediatr Clin North Am 48 (1): 53–67. doi:10.1016/S0031-3955(05)70285-6. PMID 11236733. 
  2. ↑ Riordan JM (1997). "The cost of not breastfeeding: a commentary". J Hum Lact 13 (2): 93–97. doi:10.1177/089033449701300202. PMID 9233193. 
  3. ↑ Kramer M, Kakuma R (2002). "Optimal duration of exclusive breastfeeding". Cochrane Database Syst Rev: CD003517. doi:10.1002/14651858.CD003517. 
  4. ↑ 4.0 4.1 Baker R (2003). "Human milk substitutes. An American perspective". Minerva Pediatr 55 (3): 195–207. PMID 12900706. 
  5. ↑ Agostoni C, Haschke F (2003). "Infant formulas. Recent developments and new issues". Minerva Pediatr 55 (3): 181–94. PMID 12900705. 
  6. ↑ 6.0 6.1 Horton S, Sanghvi T, Phillips M, et al (1996). "Breastfeeding promotion and priority setting in health". Health Policy Plan 11 (2): 156–68. doi:10.1093/heapol/11.2.156. PMID 10158457. 
  7. ↑ "Breastfeeding and the Use of Human Milk - AAP policy statement" (February 2005). Retrieved on 2008-08-08.
  8. ↑ 8.0 8.1 8.2 8.3 "Exclusive Breastfeeding". WHO: Child and Adolescent Health and Development: Breastfeeding. Retrieved on 2008-09-22.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Gartner LM, et al (2005). "Breastfeeding and the use of human milk". Pediatrics 115 (2): 496–506. doi:10.1542/peds.2004-2491. PMID 15687461. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496. 
  10. ↑ Secretariat, World Health Organization (2001-11-24). "Infant and Young Child Nutrition: Global strategy for infant and young child feeding" (PDF)., World Health Organization. WHO Executive Board 109th Session provisional agenda item 3.8 (EB109/12). 
  11. ↑ Dewey KG, Heinig MJ, Nommwen LA. Maternal weight-loss patterns during the menstrual cycle. Am J Clin Nutr 1993;58: 162-166
  12. ↑ 12.0 12.1 "Breastfeeding". Centers for Disease Control and Prevention. Retrieved on 2007-01-23.
  13. ↑ 13.0 13.1 13.2 13.3 "Benefits of Breastfeeding". U.S. Department of Health and Human Services. Retrieved on 2007-01-23.
  14. ↑ Ip S, Chung M, Raman G, et al (2007). "Breastfeeding and maternal and infant health outcomes in developed countries". Evid Rep Technol Assess (Full Rep) (153): 1–186. PMID 17764214. 
  15. ↑ Horwood LJ, Darlow BA, Mogridge N (2001). "Breast milk feeding and cognitive ability at 7-8 years". Arch. Dis. Child. Fetal Neonatal Ed. 84 (1): F23–7. doi:10.1136/fn.84.1.F23. PMID 11124919. 
  16. ↑ author=W.Sadler,L.Sadler | The Mother and Her Child | 1916 |Part II
  17. ↑ 17.0 17.1 Dewey KG, Heinig MJ, Nommsen-Rivers LA (1995). "Differences in morbidity between breast-fed and formula-fed infants". J. Pediatr. 126 (5 Pt 1): 696–702. PMID 7751991. 
  18. ↑ Coutsoudis, A., Goga, AE, Rollins, N., Coovadia, HM. (2002) Free formula milk for infants of HIV positive women: blessing or curse?. Health Policy and Planning 17, 154-160.
  19. ↑ Kunz C, Rodriguez-Palmero M, Koletzko B, Jensen R (1999). "Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates". Clin Perinatol 26 (2): 307–33. PMID 10394490. 
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References

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