Abstract

  Exclusive breastfeeding is recommended for all infants upto 6 months of age. However, all mothers are not able to exclusively breastfeed their babies upto 6 months and discontinue/are forced to discontinue breastfeeding partially or fully and introduce top milk or complimentary feeding before 6 months. This leads to various infections and malnutrition in infants due to early introduction of unhygienic and inadequate feeds. Objective: To study the causes of failure of lactation in mothers giving supplementary feeds to babies below 6 months and to study the effect of intervention. Design : Prospective study. Method: 100 underweight­for­age babies on supplementary feeding before 6 months of age and attending the Child Health Promotion Clinic (CHPC) of Kalawati Saran Children’s Hospital, Delhi were enrolled after obtaining an informed consent over a period of 3 months. The mothers were interviewed for feeding practices, their own diet, rest/stress, knowledge regarding feeding and diet, reasons for failure of breastfeeding and the treatment taken, if any. Case–specific advice was given to the mothers regarding proper attachment, positioning, exclusive breastfeeding upto 6 months and extra diet, and rest. They were asked to comply with the advice and followed up every week for 4 weeks. Metoclopramide (10 mg TDS) was advised only when non –pharmacological methods were not effective. They were asked to report back in case of any adverse effect(s). Observations: The response was measured in terms of decrease in supplementary feeding and /or re establishment of exclusive breastfeeding. Subjects: A total of 100­ 62 male and 38 female babies were enrolled in the study. 38 babies were 0­2 months, 40 were 2­4 months and 22 were 4­6 months of age. Out of the 100 mothers, 62 mothers were 20­24 year old, 27 were 25­29 year, 9 were 30­35 year and 2 were > 35 year old. 59% were first time mothers. Feeding pattern: On being interviewed , it was found that 79 babies were on top milk. 40 were bottle fed and 39 were on katori/spoon feeds. Maternal education : 15% mothers were illiterate, 66 % had completed school (12th grade) and only 15% had college education. Only 58% had knowledge regarding the advantages of breastmilk. Maternal diet: 32% mothers did not have adequate knowledge regarding requirement of extra­diet/nutrition during lactation. 74% were consuming less food than they were consuming during pregnancy ie only 26% were consuming more food than during pregnancy. Family support : Only 80% mothers had family support available to them during lactation period. 67% mothers started top feeding the baby at onset of slighted problem. Out of these, 45% started bottle feeding. Only 27% sought the advice of a medical personnel/doctor. Best results (100%) in establishment of exclusive breastfeeding after councelling were obtained in problems in attachment/ positioning /nipple, baby’s illness, not getting enough diet, mother too busy in housework and family pressure to stop breastfeeds. Superstitious mothers who believed that their milk was poisonous, also benefitted from councelling and were able to reestablish lactation. Positive results of counseling were observed in solving the problems of lactation, caused due to misconceptions and re­establishment of exclusive breastfeeding was seen in a large number of mothers. Conclusions: Counseling was especially helpful in solving the problems of lactation, caused due to misconceptions and baby/breast disorders. More stress is required on adolescent education, and antenatal and postnatal counseling regarding adequate maternal diet and family counseling in national programmes in our country. 

Keywords: Breastfeeding; Counceling; Lactation.

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