National Breastfeeding Week from August 1 - 7:

Breastfeeding: key to healthy, smart, future citizens

By Carol Aloysius

The National Breastfeeding Week which coincides with the WHO Breastfeeding week falls this week.

Consultant Community Physician, Family Health Bureau, Ministry of Health, Dr Dhammica Rowel, explains the significance of this week and why breastfeeding paves the way for a healthy nation.

Excerpts ...

Question: National Breastfeeding Week is being observed this week. What is the theme the Health Ministry has chosen for this special week?

Answer: The theme for the National Breastfeeding Week 2013 is "Breastfeeding Support; Close to Mother".

Q. How relevant is it to the Lankan mother?

A. Breastfeeding is a culturally accepted phenomenon in Sri Lanka. Almost all the Sri Lankan mothers initiate breastfeeding and want to breastfeed their babies. However, some of them fall short of the recommended period for exclusive breastfeeding under our national program which is for a completed six months, and continuation of breastfeeding with adequate complimentary feeding up to two years or beyond. This indicates mothers need support from immediate family, health care workers, work places, and community/peer support groups for them to successfully breastfeed. This is why we chose this theme.

Q. Why is breast milk so important to the newly born infant?

A. Breastfeeding is the most important intervention to keep the newborn healthy and prevent newborn morbidity and mortality. For the newborn, there are not only short term benefits, but many long term benefits of breastfeeding. It has to be understood that breastfeeding is a process and it entails receiving much needed breast milk as well as receiving benefits from the process of breastfeeding such as preventing infections in the newborn, preventing the baby getting cold and improving mother child bonding.

Q. How soon should a mother breastfeed her baby after delivery?

A. Within one hour, when the baby is ready. After delivery the baby is cleaned, wrapped and head covered with a cap and placed between the mother's breasts. When the baby is ready he/she will move towards the nipple and get attached to the breast with little support. A baby should be allowed to complete the breastfeed before any other procedure such as weighing the baby.

Q. It is said that the first milk drop from the mother's breast is the best milk the child can have. Why?

A. First drop of milk known as 'Colostrum' and named the Golden Milk, is essential for the newborn. In addition to providing appropriate nutrition for the newborn, colostrum is rich in antibodies and white blood cells that prevent neonatal infections. It has a purgative action that helps to clear the meconium from the gut. It has growth factors that help mature the newborn's immature gut, and it is a good source of vitamin A which helps to prevent infections.

Q. Compared to formula milk made from animal milk (cow, goat), plants etc, what special extra nutrients do human (mother's) milk have?

A. Human milk has proteins, fats, carbohydrates, vitamins, minerals, anti-infective factors and growth factors in the form and the amount that is essentially required to the baby. The protein in breast milk is in the right amount and is easy to digest unlike proteins in animal milk based formula. Essential fatty acids are present in human milk and it also has the lipase enzyme required to digest fat, lipase is not present in animal milk and hence fat digestion is poor when animal milk based formulas are consumed. Breast milk has plenty of lactose and especially oligosaccharides which also have anti-infective properties. Also human milk has anti-infective factors (IgA, Lactoferine, Lysosyme) and growth factors that can only be present in a live fluid like breast milk and is not present in formula milk.

Q. But, don't the other milk foods also have similar nutrients? Why is human milk preferable for the new born baby?

A. Mother's breast milk is tailor made for her own baby. When a baby is born prematurely, the mother's milk will be formulated according to the needs of the premature newborn. Similarly when the baby grows according the additional needs of the baby, the constituency of breast milk will change. Also in breast milk the composition varies from the beginning of the feed towards the end of the feed. Initial feeds called 'fore milk' satisfy the intense hunger of the baby, hence it has proportionately more lactose than later milk. Later milk that is called 'hind milk' has more fat that would help increase in weight of the baby. Human milk has the ability to protect the child from infections from which the mother is affected with. The antibodies to mother's infection is secreted in breast milk to the baby, hence the baby gets protected.

Q. Is it true that human milk is easily digested by babies, while the immature kidneys find it difficult to excrete the waste from protein in animal milk?

A. Yes. Human milk is easily digested as the proteins in human milk contain 35 percent of casein and 65 percent of whey proteins. The proportion of casein to whey proteins in animal milk is 80 percent: 20 percent. Whey proteins are easily digested but casein forms hard curds which are difficult to digest. Therefore even though the percentage of proteins in formula is similar to human milk, the composition of proteins is different. This make is difficult to digest by the immature gut of the newborn. Hence the waste formed from digestion of formula will be difficult to excrete as well.

Q. Apart from providing the baby with vital nutrients required for its growth and development, what other advantages does breastfeeding have on a child?

A. Breastfeeding helps a mother and baby to form a close loving relationship which makes mothers feel deeply satisfied emotionally. Close contact from immediately after delivery helps this relationship to develop. This process is called bonding.

Babies cry less, and they may develop faster, if they stay close to their mothers and breastfeed immediately after delivery, and continue to do so.

Mothers who breastfeed, respond to their babies in a more affectionate way. They complain less about the baby's need for attention and feeding at night. They are less likely to abandon or abuse their babies.

Position

Q. How should a baby be breastfed to get the maximum benefits?

A. For breast feeding any position that is comfortable to the mother and baby can be selected. Firstly, the mother should adopt a position that is most comfortable to her. If she in the seated position, her back should be well supported, her feet well placed on the ground. For this a low wooden chair with arm rests would be ideal. Then the baby has to be positioned in a way that is comfortable to the baby and mother. Whatever position the baby adopts the following criteria should be fulfilled; the baby should be close to the mother, turned towards the mother, baby's head neck and shoulder should be in one line and the baby's whole body should be supported. Also the baby's nose or the face should be opposing the mother's nipple.

Q. How often should a new infant be fed? On demand? Within 2-3 hours?

A. On demand feeding means feeding a baby as often as he wants both day and night. The breast has to be offered when the baby shows hunger cues such as rooting, sucking the thumb and salivation.

Some people prefer to call this baby-led feeding. Once the baby is in the breast allow the baby to feed until he comes off the breast. Some babies take all the breast milk they want in a few minutes, other babies take half an hour to get the same amount of milk. But they are all behaving normally.

If a mother takes her baby off her breast before he has finished, he may not get enough hind milk. Usually when a baby has had all that he wants, he releases the breast himself. It is not necessary to feed from both breasts at each feed.

If a baby does not want the second breast, his mother can offer that side first next time, so that both breasts get the same amount of stimulation.

Q. Is breast milk sufficient to meet all the baby requires?

A. Up to six months of life all the nutrient requirements including the requirement for water of the infant can be provided by breast milk. Therefore it is not necessary to give anything up to complete six months, unless indicated due to a medical reason. Also the capacity of the stomach of a newborn is only 20ml. Therefore if this capacity is filled with non-nutrient fluids such as coriander water or fruit juices, there would not be enough space for nutritious breast milk.

Q. When a working mother has to get back to work, what advice would you give if she is to continue giving breast milk to her child?

A. It is best for the working mother to continue breast feeding even if she has to return to work before completion of six months and even thereafter with complementary feeding. The mother has to get working on a routine to express and cup feed baby and get herself organised at least one week before she start working. Breast milk can be easily expressed and fed with a cup to the infant.

The correct technique of hand expression has to be learnt by the mother at the antenatal class, from her midwife or at a Lactation Management Centre. Expressed breast milk can be kept in the outside environment up to six hours and in the lower compartment of the fridge for 24 hours and in the freezer compartment about a month.

Express your breast milk before you go to work and leave it for the career to give to your baby. Leave yourself enough time to express your breast milk in a relaxed way. Express as much breast milk as you can into several clean cups and store. Leave about half cupful (100mo) for each feed. Cover the cup of expressed milk and keep it in the coolest place that you can find at home or in a refrigerator. Before feeding the baby warm the breast milk by keeping it in a bowl of warm water. Do not boil or reheat your breast milk as heat destroys many of the anti-infective factors.

Breastfeed your baby after you have expressed as suckling is more efficient than hand expression he will breast milk that you cannot express including some hind milk.

While you are at work express your breast milk every three hours. Continue to breastfeed at night, in the early morning and at any other time that you are at home.

Q. A common myth about breast feeding is that women with small breasts don't have enough milk.

A. Breastfeeding is a normal physiological process and all the mothers who give birth to babies can breastfeed. Breast milk is produced in the alveoli and is stored in the ducts. Irrespective of the size of the breast the number of alveoli and the ducts are the same in all the breasts. Therefore, all mothers can produce enough breast milk for one, two or more babies. They can all produce more than their babies need. Production of breast milk is dependent on suckling or removing milk from the breast. The breast will produce the amount of milk that is evacuated from the breast at each feed or by expression. Every mother should be taught how she can assess whether her baby is getting enough breast milk.

Q. When should a mother start complementary feeding?

A. The evidence based National Guideline is to start complementary feeding at six months as it has been found that breast milk can provide adequate nutrition to an infant up to six months of age.

Q. You have told us how a mother can protect her child from infection, strengthen his immunity and promote his growth with breast milk. Tell us what benefits the mother will have by breast feeding her baby, health wise.

A. Breast feeding helps a mother shed the extra weight gained during pregnancy and regain her pre pregnancy shape. This helps reduce obesity in the mother later in life. Also breast feeding is known to reduce the risk of breast cancer in the mother, it is found that the longer you breastfeed your risk of breast cancer is reduced. Also it reduced the risk of ovarian cancer, diabetes mellitus and high Cholesterol later in life. And above all breastfeeding makes a mother happy and content.

Q. Can teen mothers breastfeed after delivery, since their own bodies are still developing?

A. Teen mothers also can breastfeed just like other mothers as the physiology is the same. But the important thing is they will need extra support to establish and continue breastfeeding. The families of teen mothers and health workers have to provide the teen mother with emotional and physical support to continue breastfeeding.

Q. This being the 21st Anniversary of the National Breastfeeding week in Sri Lanka briefly tell us the progress made in promoting exclusive breastfeeding among mothers. Do you have a target to reach? Are you getting close to it?

A. Sri Lanka as a nation has the best breastfeeding indicators. Over the years our breastfeeding initiation rates, exclusive breastfeeding rates have increased. In 1993 when the recommendation to exclusive breastfeed was only for four months only 18 percent did so.

As a country we have progressed very well with regard to breastfeeding. Our current target is to increase the proportion of newborns who initiated breastfeeding within one hour from 85 percent (2007) to 95 percent by 2016 and to increase the exclusive breastfeeding rate at six months from 76 percent (2007) to 90 percent by 2016. Our local surveys indicate that we are reaching the targets.

Q. Your message to Lankan mothers?

A. Breast milk is the most precious food you can give your newborn infant at the most vulnerable time in his/her life. All the mothers have a right to breastfeed and newborns have a right to receive breast milk. New mothers must learn about breastfeeding during the antenatal period and get all the support they require from the hospital and the field health staff and breastfeed your baby.

Scientists grow an ear from living tissue

Scientists have built an artificial human ear by combining living tissues from cows and sheep and growing them around a flexible wire frame that retains the correct anatomical shape of the organ.

It is the latest development in 3D tissue engineering where substitute organs are made in the laboratory in the hope of using them to replace the damaged or missing body parts of patients.

The artificial ear is described as a "proof of concept" prototype, and further research and development will be needed before it could be used in clinical transplants on patients.

However, medical researchers hope that patients with missing or deformed outer ears, such as children suffering from a congenital deformity called microtia, might soon be offered living substitutes that could be permanently attached to their heads.

A key feature of the artificial ear is a cartilage scaffold with an embedded titanium wire which retains the shape of the structure as well as maintaining its flexibility, said the researchers from the Massachusetts General Hospital in Boston.

"The technology is now under development for clinical trials, and thus we have scaled-up and redesigned the prominent features of this scaffold to match the size of an adult human ear and to preserve the aesthetic appearance after implantation," they said in the study, published in the Journal of the Royal Society Interface.

Collagen connective tissue from a cow was formed into the shape of a human pinna - the fleshy visible part of the ear - and held in place by titanium wire. The porous collagen was then "seeded" with ear cartilage cells taken from a sheep and the cells grew within the porous collagen fibres.

The scientists grew the ear on mice and rats lacking an immune system to show that it was possible for it to be connected to a blood supply without tissue rejection.

In a human transplant, the ear would have to be either made from a patient's own stem cells or used with anti-rejection drugs.

An important feature of the technology is that the ear can be designed to look as natural as possible by pulling the skin taut over the wire and cartilage frame using vacuum suction, the scientists said.

Earlier this year, scientists from Cornell University in New York made a similar artificial ear built from an injectable gel produced by 3D printing to mimic the precise shape of the real organ.

- The Independent

Human tooth grown using stem cells taken from urine

Scientists in China say they have successfully grown a human tooth using stem cells taken from urine.

Researchers say the technique could one day be used as a way to replace teeth lost through aging and poor dental hygiene, with the added bonus that urine is deemed a less controversial source of stem cells than human embryos.

The team at the Guangzhou Institute of Biomedicine and Health extracted cells contained in the urine which would normally be passed from the body, such as those from the lining of the body's waterworks, and managed to coax them into becoming stem cells.

They then used these to implant the teeth-like structures in mice, and said the resulting bundle of cells eventually contained "dental pulp, dentin, enamel space and enamel organ," researchers said.

The report, added that this could lead to further studies resulting in "the final dream of total regeneration of human teeth for clinical therapy".

However, the project has received has attracted criticism, and not just because it has only a 30 percent success rate in its current form. Prof Chris Mason, a stem cell scientist at University College London, told the BBC urine was "probably one of the worst sources" of stem cells.

He said: "There are very few cells in the first place and the efficiency of turning them into stem cells is very low. You just wouldn't do it in this way."He also said the risk of contamination was much higher than with other sources of cells, and that there was a long way to go before science overcame "the big challenge" of getting nerve and blood vessels to integrate in newly-formed permanent teeth.

- The Independent