Monday March 10 2014

When your baby cannot breastfeed



NET photo

NET photo 

By ESTHER OLUKA & BEATRICE NAKIBUUKA

Exclusive breastfeeding for the first six months is recommended for every child. As much as this is the case, some mothers find it hard to adhere to this advice.

Janet Achom, for instance, is a busy working mother of one, a boy named Daniel, aged only five months.
Achom has been having trouble breastfeeding him because of her numerous business trips upcountry after she got back to work when the baby had only made three months.

“My frequent trips from Kampala to Gulu District denied me the opportunity to spend ample time with my son,” she says.
She wishes that her maternity leave had been at least six and not three months.

There are many mothers out there who are stuck in the same situation like Achom’s. They want to breastfeed but the situation at hand does not allow them to.

Dr Sabrina Bakeera Kitaka, a paediatrics specialist at Mulago hospital says for some mothers infected with HIV/Aids, breastfeeding is a very big issue. “They have fears of transmitting the virus onto their children,” she says.

She adds that it is very important for such women to know that the chances of spreading the virus to a baby are minimal if they are taking the right kind of medication.

Dr Kitaka further says some other women may not be able to breastfeed for medical reasons.

“It can be because a mother has had a double mastectomy (removal of both breasts) probably due to breast cancer or she is on a particular treatment that does not allow her to breastfeed.”

Gloria Nabaasa, a nutritionist at Mwanamugimu Nutrition Unit in Mulago hospital, says first-time mothers especially the teenage ones may also find trouble breastfeeding because they do not know how to attach and position the baby’s mouth.

She shares that mothers with medical conditions such as mastitis (inflammation of the breast that is usually caused by a blocked milk duct that has not cleared) or those with inverted and sore nipples find it difficult for a mother to breastfeed. The good news is that all these conditions can be rectified if medical assistance is sought.

Early introduction of solid foods
Nabaasa says introducing a baby less than six months old to other foods can also deter them from breastfeeding. This is because the baby can easily get confused by the different tastes and may end up preferring the other foods to the breast milk.

Babies born at a low birth weight also find it hard to breastfeed because of their weak body muscles. Feeding only becomes easier when they start gaining weight.

Babies with medical conditions such as a cleft lip (a congenital deformity caused by an abnormal facial development during gestation) also find it hard to suckle because their mouths are unable to have a firm grip on the breast.

Also, a mother may fail to breastfeed her baby either because she fears doing it in public. Other babies are denied the opportunity of breastfeeding when their mothers die shortly after they are born. There are even some cases, though rare, of mothers who have trouble producing breast milk because of various medical conditions. One such mother is Karen Balwa who has a daughter now aged one year.

“I was not able to breastfeed her well because there was not enough blood going to the posterior pituitary. I had low blood pressure,” Balwa says.
The pituitary is responsible for releasing prolactin, a hormone that allows breast milk to be produced.

In order to stimulate more breast milk, Jennifer Mugisha, a freelance nutrition consultant, advises mothers who have trouble producing milk to take a lot of liquids such as water, juice and porridge. Watery fruits are also very helpful mostly, pineapples and water melons. A mother’s body is drained a lot during the time of breastfeeding. So taking a lot of liquids helps replace the body’s lost fluids including breast milk.

Assess the situation first
For any mother who has failed to breastfeed her baby for whatever reason, Nabaasa advises them to always seek guidance from a trained health worker who will help assess their situation and advise them accordingly.
“It is very important for mothers to get this kind of help because they can be counselled as well as availed alternatives to consider,” Nabaasa says.

Options for babies less than six months
Instant formulas
In case the baby who is not breastfeeding is less than six months, Mugisha explains that instant formula milk is the immediate option.
“Baby formula is processed like breast milk so as to give the right balance of nutrients to the infant as well as make it easily digestible,” Mugisha explains.

Some babies may, however, be allergic to the proteins in the cow’s milk which the majority of formulas are made out of. Mugisha states that these infants’ mothers can opt for soy-based formulas since they exclude animal’s proteins from the baby’s diet.

But there are also protein hydrolysate formulas that have been broken down into smaller sizes than those in cow’s milk and soy based formulas.
“These are good for babies who are allergic to either cow milk or soy-based formulas,” she states.

Even with these advantages, Mugisha explains that instant formula is not as sufficient as breast milk because some vitamins and amino acids are lost during the drying off process and also the poor preservation and storage methods may alter the content and quality of the formula. Also, some mothers may not know what concentration to give a child so it can either be too concentrated or too diluted. On the other hand, some mothers use contaminated water and this in the long run puts the child’s health at risk.

Cow’s milk
Since not every mother can afford instant formula, the other option could be cow’s milk. Mugisha says it is however not as good as breast milk or instant formula. “It has a higher concentration of proteins and minerals which are not easily digestible by the infant,” he states.

If a mother must feed her baby on this milk, Mugisha encourages them to have it boiled well and cooled in a clean and dry place before giving it to the baby. For mothers who use feeding bottles, they should ensure that they use more than one, washed very well before putting milk inside.

One should add water to the milk because it lessens the high concentration of some of the nutrients in the milk. Giving baby highly concentrated milk can easily cause duodenal problems because it is not easily digested. Sugar can also be added because it is an extra source of energy for the baby.

After six months
It is now here that the mother is free to complement the baby’s diet with other foods. These include balanced diet meals composed of a protein such as eggs, energy, fat, vitamins especially vitamin A and minerals. Some of the foods rich in vitamin A include fruits like mangoes and leafy vegetables which also contain minerals such as calcium.

Infants also need the zinc mineral that will maintain their immune system and normal growth. Some of the foods rich in zinc include fish, red meat and eggs.

Children feed more than six times a day on complementary foods in form of drinks and solid food.
But just like the instant formula and cow milk, mothers must ensure that they prepare the food in a clean and safe environment.

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