4.2.1  Key messages for optimal breastfeeding practices

An important part of your job is connected to helping mothers and caregivers to feed their children in the most effective way possible. It is therefore very important that you help them to understand the importance of optimal breastfeeding. The following are key messages that need to be explained to the mother. You should make sure that she understands why these behaviours are important and that you have given her the underlying reasons for each of the key messages. You will be using these messages when you are educating or counselling mothers.

The mother initiates breastfeeding within one hour of birth

Initiating breastfeeding within one hour protects the infant from disease by providing the thick, yellowish first milk (colostrum) which is the equivalent to the infant’s first vaccine. It also helps to expel the placenta more rapidly and reduces blood loss by the mother. It also helps expel meconium (the infant’s first stool), stimulates further breastmilk production and keeps the newborn warm through skin-to-skin contact.

The mother breastfeeds frequently, day and night

The mother should allow the infant to breastfeed on demand (as often as the infant wants) (see Figure 4.2). This means feeding every two to three hours (8–12 times per 24 hours) or more frequently if needed, especially in the early months. The mother needs to breastfeed frequently to stimulate milk production. Breastmilk is perfectly adapted to the infant’s small stomach size because it is quickly and easily digested.

Mother breastfeeding her baby
Figure 4.2  Feeding on demand is best for babies.

The mother gives infant only breastmilk for the first six months.

The mother needs to breastfeed frequently to stimulate milk production.

Breastmilk contains all the water and nutrients that an infant needs to satisfy its hunger and thirst. Exclusive breastfeeding helps to space births by delaying the return of fertility. Exclusively breasted infants are likely to have fewer diarrhoea, respiratory, and ear infections. You should encourage and support the mother to exclusively breastfeed her baby, explaining how it will help both her and her infant (see Figure 4.3).

Health Extension Practitioner counselling a mother on exclusive breastfeeding
Figure 4.3  Health Extension Practitioner counselling a mother on exclusive breastfeeding. (Photo: UNICEF Ethiopia / Indrias Getachew)

The mother continues breastfeeding when either she or the infant is sick

Sick infants need breastfeeding more frequently.

If the mother is sick with a cold, flu or diarrhoea, she can continue to breastfeed because breastmilk still protects the infant against illness. If the infant is sick, mother has to breastfeed more frequently (or express her milk if the infant cannot breastfeed) so that the infant recuperates faster. Breastmilk replaces water and nutrients lost through frequent loose stools, and is the most easily digestible food for the sick infant.

The mother positions and attaches infant correctly at the breast

The mother has to position and attach the infant to the breast correctly to help prevent sore or cracked nipples, and to stimulate her milk supply. Signs that infant is properly positioned are:

  • The infant’s whole body is facing the mother and is close to her
  • The mother holds infant’s entire body, not just the neck and shoulders.

Signs that infant is properly attached include:

  • The mother brings infant toward her breast, not the breast toward her infant
  • The infant’s mouth is open wide
  • The infant’s lips are turned outwards (like a fish mouth)
  • The infant’s chin touches the mother’s breast
  • The mother’s entire nipple and a good portion of the areola (dark skin around the nipple) are in the infant’s mouth
  • More areola is showing above rather than below the nipple.

The IMNCI Module provides more details about effective breastfeeding and how you can support mothers to achieve this.

The mother offers the second breast after the infant releases the first

The mother has to allow the infant to release the first breast before offering the second breast so that infant receives both ‘fore milk’ which has a high water content to quench the infant’s thirst, and ‘hind milk’ which is rich in fat and nutrients. The mother should not give bottles and pacifiers (dummies) to her breastfed infant because they can interfere with breastfeeding and cause diarrhoea and other possibly serious infections as they are difficult to keep clean.

The mother should eat more than usual

As breastfeeding increases the nutritional requirements of the mother, she needs to have two additional meals (about 500 kcal) every day. Her diet should also be varied (for example by adding vegetables and fruits).

By the age of six months the mother or caregiver must add complementary food

The complementary food given to the child should be varied as much as possible, increasing the quantity, frequency and density of the food as the child gets older. This is in addition to the need for the mother to continue breastfeeding until the child is two years of age or older.

  • Why should the mother switch the baby to the second breast only after completely suckling the first one?

  • It is important because the fore milk has a high water content to quench the infant’s thirst and the baby also needs to get the hind milk which is rich in fat and nutrients.

4.2  Global and national recommendations for child feeding during the first 24 months

4.3  Benefits of breastfeeding for the baby