Breast milk alone for the first six months, then breast milk plus food until two years or beyond. That is the recommendation, and in a place where water is not always safe, it is also protection against the illnesses that fill the children’s ward.
The first days
- Start within the first hour after birth.
- The thick yellow first milk, colostrum, is concentrated protection. It is not "dirty milk" and it should never be discarded.
- Feed on demand, at least eight to twelve times in 24 hours, day and night.
- Skin to skin as much as possible. It helps the milk come in.
Exclusive means exclusive
For the first six months: no water, no glucose water, no herbal teas, no pap, no other milk, even in hot weather. Breast milk is about 88% water and covers the need. Anything else added in those months displaces milk and carries whatever was in the water.
Getting the latch right
- The baby’s mouth wide open, taking the nipple and a good part of the areola, not just the tip.
- Chin touching the breast, nose clear, lower lip turned out.
- You hear swallowing, not clicking.
- It should not be painful. Pain almost always means the latch, and a health worker can fix it in one visit.
Is the baby getting enough
About six wet nappies a day after the first week, regular stools in the early weeks, steady weight gain, and a baby who settles after feeds. Those are the signs. A baby feeding often is normal, not a sign of too little milk; and soft breasts after a few weeks are normal too.
Common problems, all fixable
- Sore or cracked nipples: almost always the latch. Fix the latch, and express a little milk onto the nipple after feeding.
- Engorgement: feed often, express a little before the feed to soften, warm before and cool after.
- A hot, red, painful area with fever: this is mastitis. Keep feeding from that breast, and go to a health worker; it often needs treatment.
- "Not enough milk": usually the fix is feeding more often, not less. Supplementing reduces the supply further.
From six months
Start soft family food, thick enough to stay on a spoon, two to three times a day at first, while continuing to breastfeed. Add an egg, fish, beans, groundnut paste, liver, and dark green leaves. Keep breastfeeding to two years and beyond; it continues to give nutrition and protection.
When to ask for help
- The baby is not feeding, or feeding much less than before.
- Fewer than six wet nappies a day after the first week, or no weight gain.
- The baby is very sleepy, floppy, or hard to wake.
- A hot red painful breast with fever in the mother.
- Yellow skin or eyes in the baby.
If the mother is living with HIV
A mother on effective treatment should breastfeed. The advice changed: with treatment the risk of passing HIV through milk is very small, and not breastfeeding carries its own serious risks here. Follow the advice given at the clinic and stay on treatment.
