Breastfeeding (Guideline 1)
HEALTHY EATING GUIDELINE 1
Exclusive breastfeeding is recommended, with positive support, for babies until around six months. Continued breastfeeding is recommended for at least 12 months – and longer if the mother and baby wish.
Breastfeeding is the first food experience for babies. It is recommended that infants be exclusively breastfed until around six months of age when solid foods are introduced, and breastfeeding be continued until 12 months of age and beyond, for as long as the mother and child desire.
The fourth guideline of the Australian Dietary Guidelines is ‘Encourage, support and promote breastfeeding’. Australia’s breastfeeding initiation rate in 2010 was high at 96%, however only 15% of infants were exclusively breastfed to around six months.
Benefits of breastmilk
Breastfeeding is the healthiest start for infants. For this reason it is recommended that mothers exclusively breastfeed until around six months of age, and then for as long as it is possible and practical. Most breastfeeding difficulties can be overcome with support and encouragement from health professionals, family and community organisations.
Breastfeeding provides benefits for babies from birth, and these benefits continue as they grow. Breastfeeding also has benefits for mothers.
Benefits for babies
The benefits of breastfeeding for babies are that:
Breastmilk has the appropriate nutrient composition for babies in each stage of development.
Breastmilk helps to protect young babies from disease – particularly gastrointestinal illness, respiratory illness and middle-ear infections.
The sucking actions of breastfeeding help shape and prepare the jaw for teeth and speech.
As babies grow…
There has been a lot of research into the health benefits of breastmilk. Most of the research and results deal with exclusive breastfeeding – where breastmilk is the only food supplied to babies during the first months of life. There are strong results to show that breastfeeding protects babies against gastrointestinal infections, respiratory infections and middle-ear infections, and lowers high blood pressure and the risk of obesity in childhood. Other research suggests that breastfeeding also lessens the effects of asthma, wheezing and eczema and improves intellectual and motor development. There is also some research to suggest that breastfeeding may reduce the risk of Crohn’s disease, allergies, type 1 diabetes and leukemia. Long-term effects of breastfeeding include reduced risk of type 2 diabetes and weight problems (overweight and obesity) in adolescence and adulthood.
Benefits for mothers
Breastfeeding also has important protective benefits for mothers, it:
assists the uterus to contract to its pre-pregnant size
lowers the risk of pre-menopausal breast cancer and ovarian cancer
protects against rheumatoid arthritis
assists the return to pre-pregnancy weight (if breastfeeding is prolonged)
reduces the risk of type 2 diabetes (if breastfeeding is prolonged).
Discussing breastfeeding with new parents
Many parents book their child into an early childhood setting soon after birth, or even before their baby is born. This is a good opportunity to let mothers know that breastfeeding is beneficial, even for a short time, and that it is possible to breastfeed and work.
Here are some tips for encouraging mothers to breastfeed:
Inform them of what the early childhood setting can offer to support her.
Inform them of where they can receive practical help if needed.
Provide factual and practical information on how to continue to breastfeed after returning to work.
Breastfeeding role models
Seeing another mother successfully breastfeed offers encouragement to new mothers. Encourage staff and carers returning to work in the early childhood setting after having a baby to continue to breastfeed. If the staff member agrees, let it be known around the setting that she is breastfeeding and encourage her to speak positively about it. Specific questions about breastfeeding should be referred to experts.
Breastfeeding and work
It is possible for mothers to return to work and still continue breastfeeding their child. Most women will need to express breastmilk for their baby to drink in the times they are apart. Mothers who work part-time or very close to the early childhood setting may be able to continue offering all feeds from the breast.
Breastfeeding and expressed milk
Expressing breastmilk allows a mother and baby to happily continue breastfeeding, with the mother providing expressed milk in a bottle for times she is away. Regularly expressing breastmilk is often easier once breastfeeding has been established. This is usually when the baby is around two to three months of age; however it is possible for mothers to successfully express milk before this time.
Offering babies breastmilk through a combination of breastfeeding and bottlefeeding usually means offering a minimum of two feeds from the breast per day – one in the morning and again in the evening, or at bedtime. In between feeds from the breast, mothers can express breastmilk to safely save for later use.
Mothers need to express milk at intervals similar to when they would normally breastfeed. Milk can be expressed by hand, hand pump or electric pump, and this needs to be practised before returning to work.
Breastfeeding and formula
Some mothers find it quite easy to develop and keep a routine of providing breastmilk for their babies. Other mothers may find it difficult to keep up their supply of breastmilk, or simply be unable to organise or find the time.
If their baby is older, say around six months, many mothers can continue to produce enough milk for these now less-frequent breastfeeds. Also, many older babies are happy to have breastfeeds supplemented by formula during the day. Expressed milk or formula can be offered in a bottle, or in a cup if the baby is seven to eight months old or more.
Maintaining enough milk for only a small number of feeds can be difficult for some mothers. If a mother finds that she does not have enough milk, she may need to express more often for a while to try to rebuild her supply. On the other hand, she may accept that the breastfeeding period is over for this baby.
A place to feed
A mother may want to breastfeed her baby at the early childhood setting at drop-off or pick-up time. If work is close by, some mothers may be able to come back and breastfeed during the day. Sometimes, a mother may need to express breastmilk at the setting for her baby to drink that day. Breastmilk expressed and stored at the setting must be labelled and stored appropriately.
Many mothers are happy to breastfeed in public, and this should be acceptable to everyone. However, some women prefer to use a quiet, private space when breastfeeding, especially when expressing breastmilk. Also, if a baby is easily distracted, they may feed better in a quiet environment. Therefore, it is important that a quiet and private space be available for breastfeeding mothers, and that both the mothers and staff or carers know about it. The breastfeeding space should have a comfortable chair and access to a power point, for mothers who use an electric pump to express milk.
Congratulations for breastfeeding!
No matter how long a mother breastfeeds her baby, she should be recognised and respected for her effort. If a mother is moving her baby onto formula, make sure she has information on how to provide formula to early childhood settings.
As with all food and drink, it is important that staff and carers practise safe handling of breastmilk. Safe handling is particularly important for breastmilk because it is a fluid from the body. Care should be taken to ensure that breastmilk does not spill or drip onto other food, and that a mother’s breastmilk is provided only to her own baby.
Labelling and storage
At home, breastmilk should be stored in sterilised bottles in the coldest part of the refrigerator (5°C or lower), and can be kept for three days (72 hours).
Milk can be frozen in a freezer compartment inside a refrigerator for up to two weeks at -15°C; three months at -18°C (for example, in a separate freezer), and six-12 months at -20°C (for example, in a deep freezer).
Milk brought to the setting should be poured into sterilised bottles (see ‘A place to feed’ above) and carried in an insulated container with an ice brick or frozen water bottle. Each bottle of milk is to be clearly labelled with the following information:
full name of child
date to be used
Bottles need to be sterilised, sanitised and disinfected to ensure that they do not carry any infections. This can be done with several different methods, including boiling, with an electric sterilising unit, through chemical sterilisation or with a microwave steriliser. Whichever method is chosen, be sure to always follow the instructions carefully.
Protocols for breastmilk
It is very important that the correct breastmilk be given to the correct baby. Giving a baby the breastmilk of a different mother is a major incident.
Staff should follow the following procedures:
If more than one baby is receiving breastmilk at a setting, two staff members need to check that the correct name is on the bottle for the baby about to be fed. This should also be noted on the baby’s record.
If a baby is given the wrong breastmilk, the setting’s usual incident procedures should be followed. This may include reporting the incident to a local authority. Staff and carers should also ask the baby’s mother to contact her general practitioner or child health nurse for advice.
How to be breastfeeding-friendly
Most mothers know that breastfeeding is the ideal feeding choice for their baby. However the decision to breastfeed is also influenced by the needs of a mother’s entire family, and other concerns she may have in her life. Some mothers may decide not to breastfeed. Many women worry that when they return to work it will be impossible to breastfeed. Some mothers may even decide against breastfeeding in the first place because they think they will have to stop when they go back to work.
Mothers need to be encouraged and supported to breastfeed, and assured that breastfeeding – even for a short time – has benefits. Offer factual information about breastfeeding as well as practical advice, and support mothers who need further information or help.
Additional breastfeeding information is available from the Australian Breastfeeding Association, either online on the website or from the breastfeeding helpline, 1800 MUM 2 MUM (1800 686 2 686).
Mothers new to the early childhood setting, or just booking in, are provided with breastfeeding information.
Any staff and carers that are breastfeeding are encouraged and supported to breastfeed.
Mothers are reminded that any amount or length of breastfeeding is good, and they are supported in their choices.
Mothers know that breastfeeding is supported into the second year and beyond, if that is what they want to do.
Mothers understand that they need to express milk as often as they would feed their baby.
A comfortable and private place for mothers to breastfeed or express milk is provided, with a power point for an electric pump.
Safe breastmilk-handling practices are maintained by all staff or carers and parents.
Mum should be encouraged not to drink alcohol while breastfeeding and keep baby away from cigarette smoke