Breastfeeding Exclusive breastfeeding for six months has many benefits for the infant and the mother. Primarily, it prevents intestinal infections, for both developing and industrialized countries. Breastfeeding as early as possible (one hour after delivery) prevents infection and reduces neonatal mortality. The risk of death from diarrhea and other infections may be greater for partially breastfed or non-breastfed infants. For children 6-23 months of age, breast milk is also an important source of energy and nutrients. Breast milk provides half or more of the energy needs of infants 6-12 months of age and one-third of the energy needs of infants 12-24 months of age. Breastmilk is also an important source of energy and nutrients for affected children and may reduce mortality in malnourished children. Breastfed infants tend to have lower blood pressure and lower cholesterol as adults, and are less likely to develop excess weight, obesity and type II diabetes. Breastfeeding is also beneficial to the health and well-being of the mother. It reduces the risk of ovarian and breast cancer and helps space out births – exclusive breastfeeding of infants under 6 months of age can have hormonal effects that often lead to periods of lactational amenorrhea. This is a natural method of birth control called lactational amenorrhea contraception. Mothers and families must be supported in optimally breastfeeding their infants. Actions that can help protect, promote and support breastfeeding; implement the 10 steps to successful breastfeeding as outlined in the Baby-Friendly Hospital Initiative, including: initiating skin-to-skin contact between mother and baby immediately after birth and within the first hours of life; breastfeeding on demand (that is, whenever the baby needs it, day and night); mother-infant co-location (keeping mother and baby together 24 hours a day) not feeding the infant other foods or drinks, or even water; supportive health services that provide infant and young child feeding counseling during contact with caregivers and young children, such as during prenatal and postnatal care, home visits for healthy and sick children, and immunizations; and community support, including mother support groups and community health promotion and education activities. Complementary feeding Around 6 months of age, when breast milk is not meeting the infant’s energy and nutrient needs, complementary foods must be added to meet these needs. Infants can begin to eat other foods at approximately 6 months of age. If supplemental foods are not added after the infant reaches 6 months of age, or if they are not added appropriately, the infant’s growth and development will be compromised. Guidelines for appropriate supplemental feeding are as follows: Continued frequent nursing on demand until the infant is 2 years of age or older; Responsive feeding (i.e., feeding the infant directly and helping older children to eat. Patiently feed slowly, encourage children rather than force them to eat, talk to them, and maintain eye contact); develop good hygiene and proper food handling; start adding small amounts of food at 6 months of age and gradually increase the variety of food as the infant gets older; gradually achieve a reasonable mix and variety of foods; increase the frequency of infant feeding, 2-3 times a day for 6-8 month olds and 9-23 month olds Increase the frequency of infant feedings to 3-4 times a day for 6-8 month old infants, with 1-2 supplements as needed for 9-23 month old infants; provide nutritious and varied foods; use fortified foods or vitamin and mineral supplements as needed; increase the intake of fluids for infants, including increasing the frequency of breastfeeding and providing soft and palatable foods. Feeding in extremely difficult circumstances Families and children in difficult circumstances should be given special attention and practical support. Whenever possible, mother and baby should always be together and provided with the necessary support to enable the most appropriate feeding method available. Breastfeeding remains the preferred mode in almost all difficult situations, such as: low birth weight or premature birth of the infant; mothers with HIV; teenage mothers; malnutrition in infants and young children; complex emergencies in the family; children living in special circumstances, such as in foster care, or with a mother who is physically or mentally disabled, or who is serving a prison sentence or abusing drugs or alcohol. HIV and Infant Feeding Breastfeeding, especially early and exclusive breastfeeding, is one of the most important ways to improve infant survival. However, women who are infected with HIV can transmit the virus to their infants through breast milk during pregnancy, labor, or childbirth. In the past, it has been a challenge to weigh the risk of an infant contracting HIV through breastfeeding against the higher risk of a non-breastfed infant dying from causes other than HIV, particularly malnutrition and serious illnesses such as diarrhea and pneumonia. Evidence on HIV and infant feeding suggests that the use of antiretroviral drugs for HIV-infected mothers or infants at risk of HIV infection can significantly reduce the risk of HIV transmission through breastfeeding. Use of the drug reduces the risk of viral transmission (1-2%) and allows HIV-infected mothers to breastfeed their infants, thus providing the same protection from the most common causes of infant mortality, with all the benefits associated with breastfeeding. Even in the absence of antiretroviral drugs, mothers should be advised to exclusively breastfeed their infants for the first six months of life and to continue breastfeeding thereafter, unless the survival and social environment is safe enough to support replacement feeding.