FREQUENTLY ASKED QUESTIONS

FREQUENTLY ASKED QUESTIONS ABOUT BREASTFEEDING

1. Almost all infants are breastfed in Bangladesh. So why is breastfeeding consider to be a problem?

   Breastfeeding is not done properly. Most newborns are not put to the breast immediately after delivery and instead they are fed honey, sugar water, and other milk in the first few days and these are very harmful. Also, exclusive breastfeeding is practiced for less than two months by most mothers as compared with the recommended 6 months. This is also harmful.

2. What is the recommended time to initiate breastfeeding in a newborn and why?

   Newborns should be put to the breast immediately after delivery, within less than one hour because it that contains nourishment and. sucking the newborn stimulates breast milk production. It helps contract the uterus to reduce bleeding and expel the placenta more rapidly.

3. What is the difference between ‘colostrums’ and regular or ‘mature’ milk?

   Colostrums contain more fat, energy, Vitamins and nutrients. It is thicker in consistency and yellowish not white. It has many diseases fighting element.

4. Can water be given exclusive breastfeeding?

   No, exclusive means nothing else, not even water

5. Why does breastfeeding have to be exclusive and why is even water not recommended for the first 6 months?

   Water and other liquid reduce the ability of infants to consume enough breast milk.   This cause breast milk supply to decrease. Breast milk contains the best combination of all nourishment and water needed by infants until 6 months. Breast milk is free of disease causing germs but other liquids and water contains germs and toxins. Infant cannot digest any other liquid or food before six months other than breast milk.

6. It is true that breastfeeding delay pregnancy and is a good family planning method?

   Yes breastfeeding when no other liquids or solids are fed, and exclusive breastfeeding is practiced, is a reliable method of contraception and has no side effect for the first six months after delivery. Three conditions must be met for breastfeeding to be effective: exclusive breastfeeding, no other foods or liquids, only for six months and only if the mother is not menstruating. Mother should choose another method of family planning as they plan to introduce other foods in the child’s diet, definitely by six months, and immediately start another method if they start menstruating before six months.

7. What, if anything is allowed to be given to babies in the first 6 months of exclusive breastfeeding?

   Only medicines, ORS and vitamin/iron drops

8. What is the difference between the milk that baby gets early in a feed or ‘fore’ milk and later in the feed ‘hind’ milk? Why is the important?

   Early milk looks thinner/watery as it has less fat and plenty of water. Later milk is white and contains more fat. Infants who are taken off the breast quickly before they leave the breast themselves often remain hungry after a feed or become hungry soon after breastfeeding. Infants should be allowed to complete feeding at one breast and should himself/herself leave the breast.

9. What is meant by ‘milk comes in’ and what helps milk to come in? Why is this important?

   It means the milk starts to flow, Sometimes milk can be seen to come out from the nipple. Mothers thought and feeling about the infant and sensory stimulation helps the milk to flow. Mother need to have less tension, Worries, pain and doubts so that they breastfeed well.

10. What does it mean that baby is well ‘attached’ at the breast? Why is this important?

    A well attached baby can draw out plenty of milk from mother’s breast. The signs of good attachment are that the baby’s mouth wide open, the lower lip is turned outwards, the baby’s chin touches breast, and more areola/dark part of the breast is above baby’s upper lip than below. This is important as poor attachment can cause cracked and sore nipples if the infant is chewing on the nipple and not areola, and engorgement can result as milk is not fully drawn out. The reaming milk may lead to low milk production and the infant will remain hungry.

11. What do we mean by good ‘position’ for breastfeeding? Why is this important?

    Good position means the infant can easily reach the breast and attach to the breast properly for drawing out plenty of milk and the mother is comfortable enough to remain in that position as long as the infant wants to feed. A good position can be seen when the infant’s head and body are in the same line, the infant is held close to mother’s body, the infant whole body is supported including neck, head and bottom, the infant is facing the breast with her/his nose opposite to nipple, and the mother’s back is supported and she is not bending over. Poor position prevents good attachment of baby suckle plenty of milk, and the mother and/ or baby may get tried quickly so will be unable to breastfeed long enough

12. How can mother or CHW tell if the baby is suckling well and getting plenty of milk?

    This is visible signs of good sucking are slow deep sucks with pauses, checks round and filled with milk, infant release the breast when finished, some drops of milk may be visible near mouth, and mother feels breasts filling up and may be slightly harder before a feed  and breasts soften after the feed.

13. How can mother working outside the home maintain exclusive breastfeeding?

    Many mothers find it convenient to breastfeed more frequently at night so the infant makes up for the missed opportunities to breastfeed the day time. Some mothers express breast milk by hand or machine/pump and leave it in a cup to be fed by another caregiver. Breast milk can last safely. Breast milk can last safely for hours even in worm weather if the cup is clean and hands are washed with soap thoroughly before expressing. Some employer permit mothers to breastfeed at lunch time when their family member brings the infant to the worksite.

14. For how long should an infant and young child be breastfeed and why?

    For as long as the child and mother want to, but at least for 2 years. Breast milk is the quality product and provides important amounts of essential nutrients and protection from illness that no other product can. It is the safest and low cost way to feed children.

15. What do mothers say about common barriers they face for early initiation of breastfeeding?

    Mothers say they did not know how important early initiation was for the infant, and that nobody helped them put the baby to the breast. More mothers are also saying they had a c-section and were discouraged by health staff to breastfeed. But even mothers with c-sections can be supported to breastfeed as local anesthesia is commonly used for c-sections in Bangladesh.

16. What does mother say about common barriers they face for exclusively breastfeeding for 6 months?

    Most mother say they did not have sufficient breast milk and that a ‘doctor’ prescribed breast milk substitute. Insufficient milk is frequently a misperception based on a child’s crying that can result from many other causes. Good techniques of breastfeeding, breastfeeding frequently day and night and not giving any other water or liquids can increase the supply of breast milk. Most mothers need to be given confidence, taught simple skills, and enough time to breastfeed well for 6 months. Most mother do not know when the child is exclusively breastfed and passes time 6 or more time a day, it means the breast milk supply is plenty.

FREQUENTLY ASKED QUESTIONS ABOUT COMPLEMENTARY FEEDING

1. What is the recommended time to start feeding or liquids other than breast milk to infants, and why?

   After completing six months it is safe to add other foods as the child can not digest other foods before this age. Also, other foods and liquids, even water, fill up the child’s stomach and so s/he not suckles enough breast milk. Breast milk is the most nourishing food, safe and hygienic. Breast milk can meet complete nutritional needs. Others food can introduce infections and toxins

2. What are the most common barriers to adequate complementary feeding at 6-23 months?

   Mothers say they did not know how much and what types of food are important, particularly the amounts that a 6-12 month old infants needs to consume daily. They also did not know a young child can eat animal foods. Many did not know how to encourage children to eat enough and did not have time to feed a young child patiently as they have many household chores. Research shows that children in the 6-23 month age group are frequently ill.

3. What are the ideal foods for the breastfed infants after they are 6 month old?

   Mashed family foods are ideal, such as soft, cooked rice (not liquid or rice water) with mashed dal solids (not liquid or dal water) small pieces of cooked and mashed pumpkin, rips papaya and mango, plus mashed, well cooked egg and deboned fish, on mashed chicken liver at least once daily. Breastfeeding should continue day and night and whenever the child asks for it.

4. How can you tell what is semi-solid f   food for the baby?

   Food that is thick enough to stay in the fingers when picked up. If using spoon, the food should not pour out but remains in the spoon.

5. How can breastfed babies be taught to eat semi-solid foods?

   By mashing soft family foods very well, maxing with a spoon of oil or breast milk, by trying small amounts repeatedly until the child shallows and by offering favorite, tasty, slightly sweet foods.

6. What is the amount of complementary food a child should eat from 6-24 months?

   About 250 gm per day or one large bati or two small batis divided into 2 or 3 meals from 7 to 8 months, 375 gm per day or about 11/2 large bati or 3 small bati divided into meals at 9-11 months, and over 600gm daily or almost 3 large batis or 4 small batis plus nourishing snacks several times a day in addition to breastfeeding.

7. What are the dangers of poor complimentary feeding for the child?

   Reduces brain growth and the ability of child to fight infection, introduces germs causing disease if hands are not washed thoroughly with soap before food preparation or feeding of young children. Slows growth, causes under nutrition and the child remains hungry and her/his appetite decreases.

8. What do we mean by ‘responsive feeding’?

   When mothers respond to the child’s interest by praising and encouraging child’s eating. Mothers don’t try to force the child to eat when the child is not interested to eat; she pauses asking if child is hungry and waits until child is hungry. The child is encouraged to feed herself/himself after about 8 or 9 months of age. Child’s favorite foods are offered. Foods are given as well-mashed foods when infants are small and in small pieces as they grow older so that they can pick up foods and feed themselves after about 8 or 9 months.

9. Why responsive feeding is is important?

   Responsive feeding is important because it encourage children to eat enough food until they are no longer hungry. It improves the child’s appetite. It stimulates the brain, improves the child’s co-ordination and builds motor and communication skills. After they learn to feed themselves, it saves mother’s time.

10. How can a mother or CHW tell if the baby is getting sufficient complimentary food?

    A child is receiving enough if, when the child is given plenty of time and the right types of foods she/he stops eating when food is offered; finishes all the food he/she was given recommended amounts. If child is energetic, plays well and is not sleepy all the time. Weighing the child to see if he/she is gaining enough weight is the best way to know that complimentary feeding is adequate.

11. What foods are good sources of vitamins and minerals?

    Animal food such as eggs, chicken liver, mashed/ground meat, deboned large fish or ground up small fish. Also, milk and dairy products such as yogurt and paneer. Shaak (dark green leafy vegetables), pumpkin, ripe mango and papaya and kathel.

12. Why are animal foods they important for feeding infants and young children?

    They contain a high concentration of vitamins and minerals, energy giving fat and the best quality of protein that plant foods don’t have. As the child’s stomach capacity is small, adding animal foods to the child’s diet will help ensure his/her needs can be met.

13. What are some reasons for mothers reporting ‘poor appetite’ in children of 6-23 months?

    Mother does not spend enough time to allow children to eat well. They sometimes try to force feed and this discourages children who like to be encouraged and praised rather than having a bad experience during meal times. The food does not taste good to child or is repeated too many time and does not have variety. The child is sick. The child is tired or sleepy when offered food. Child’s stomach is full of chips, juice, water/liquids.

14. How can other family members help to achieve good complementary feeding practices?

    Share household chores with child’s mother/caregiver so she can spend time feeding young children. They should encourage, remind and support mother to feed the child properly. Fathers in particular should provide animal food animal foods daily to feed the child. Family members should not offer non-nutritious, food or junk foods such as chips, juice, water or liquids.

15. What are some nourishing snacks for children 6-23 months?

    These are some example: Cooked chicken liver or fried fish without bones; pieces of ripe mango or papaya or jackfruit; Cooked/fried pumpkin; pieces of fried potato or fried banana; yogurt or pieces of paneer; pieces of cooked egg.