Role of Breastfeeding & Complementary Feeding in controlling Child Anemia

Dr. Anchita PatilUSAID/India

IAPSM Conference, 2010-11In absentia presented by:

Dr. A. K. GuptaState Coordinator UP

USAID Micronutrient Project

IAPSM 2010

NFHS-3 reports are worrying …

Anemia rates in children 6-35 months• India: 78.9%• Jharkhand: 78.2%• UP: 85.0%• Kerala: 56.1%

IAPSM 2010

The story starts with the mother’s nutritional status

Low iron reserves in mother

Reduced iron transferred to fetus

New Born starts life without adequate iron

stores.

Overall malnutrition in mother (usually linked

with IDA)

LBW baby

IAPSM 2010

Till of age …

Iron Stores from mother

(delayed cord clamping)

Exclusive breastfeeding for six months

Enough to maintain the iron stores for the baby

IAPSM 2010

• Low iron content, but high bioavailability (50%)

• Vitamin A in Breast Milk helps in iron transport and metabolism.

• Reduced infections, especially diarrhea prevents losses / impaired absorption.

• Animal milk consumption gut lesions blood losses

How does BF work against child anemia?

IAPSM 2010

Beyond six months …

Infant needs increase

6 -12 months, Recommended Daily Allowance for Fe: 11mg/day

( 0.8 mg of Absorbed Fe)

Breast-milk not enough

Complementary Feeding initiated

+ Iron Supplementation

IAPSM 2010

• Adds-on to low quantity / better bio-availability Fe in Mother’s milk.

• Improve overall nutrition

• Increased availability of absorption facilitators.

How does CF work for child anemia (Complementary Feeding)

IAPSM 2010

Complementary Feeding

• Balanced energy - dense diet• Foods with heme iron• Avoid tea / coffee (absorption

inhibitors)• Fortified foods

• Continue breast feeding

IAPSM 2010

Breastfeeding Myths

Myth 1:

Breastfeeding is simple

If it’s so simple, why aren’t women doing it?

Reality: Breastfeeding is natural, not easy!!

IAPSM 2010

Not enough milk

PERCEIVED PROBLEM• Breasts don't seem full• Baby cries soon after

feeding

EXPLANATION• Genuine lactation failure –

an extremely rare event• Babies have variable

hunger cycles• Attachment / position• Baby cry has other causes

• Reassure: weight gain, urine frequency.

• More sucking produces more milk.

IAPSM 2010

Artificial feeding

PERCEIVED PROBLEM• Bottle feeding is easier• Formula IMS as good as

breast-milk

EXPLANATION• Bottle-feeding has huge

issues related to increased infections and nipple confusion

• The “processes” related to bottle feeding (cleaning regime, preparing formula) is more difficult.

• Formula milk has no antibodies, enzymes etc. and does not vary with feed duration, age of baby, season etc.

IAPSM 2010

Breastfeeding is consuming

PERCEIVED PROBLEM• A breast-feeding mother is

home-bound.• Babies should be bottle-fed

at night to avoid disturbing the mother

EXPLANATION• A breastfeeding mother is

free, as she is her baby’s food!!

• Night feeds increase baby’s satiety levels and therefore sound sleep at night

• Most babies develop their own rhythm soon and will sleep for longer periods in the night.

IAPSM 2010

Breastfeeding myths

Myth 2:Informing women about the benefits of breastfeeding will ensure appropriate behavior change

If education is the answer, why are breastfeeding rates lower in the “educated” women?

Reality: A “supportive environment” is essential to ensure “compliance” to

IYCF guidelines.

IAPSM 2010

Working women

PROBLEM• Women need to join work

often as soon as a few weeks after delivery

• Pumping does not maintain milk supply as well as suckling does

POTENTIAL SOLUTION• Maternity break for at least

6 months (investing in the future)

• Improved work-place policies

• Research for viable options …..

IAPSM 2010

Family and community support

PROBLEM• Absence of comfort has a

negative psychological effect on mother with detrimental impact on milk production and flow

• Health care providers promote formula

POTENTIAL SOLUTION• Health care providers need

intense training• Stronger implementation of

IMS Act• Counseling of family along

with mother • Breastfeeding should be a

social norm

IAPSM 2010

Complementary Feeding Myths

Myth 1:Complementary feeding is learnt by trial and error

Reality: Complementary feeding / responsive feeding is an art and science both. It can be and needs to be taught to the caregivers.

IAPSM 2010

Complementary Feeding myths

Myth 2:Complementary feeding is meant to replace breast milk as amount of breast-milk reduces after six months

Reality:• Complementary feeding is

not “weaning-off” the breast, but adding on to breast-milk

• Breast milk production does not reduce after 6 months; baby’s requirements overshoot the supply.

IAPSM 2010

Complementary feeding myths

Myth 3:If complementary feeding is given in adequate amounts, it has enough iron to meet the child’s needs

Reality• Babies may start off life with

low iron stores• Child’s requirement (per kg

weight) is much more than adults.

• More difficult if foods have less bioavailability iron therefore more food bulk needed.

• Supplementation is almost always necessary.

IAPSM 2010

Iron Deficiency Anemia in children - a complex issue

• Maternal nutritional status, determines birth weight and iron stores

• Period of exclusive breastfeeding

• Age of Complementary feeding (increased iron requirement vs. risk of infections)

• Dietary diversity in complementary food

IAPSM 2010