Breastfeeding; are highly active in the first few minutes

Breastfeeding; a way of providing ideal nourishment foradequate growth and development of children and the advantages range fromphysiological to psychological for both mothers and children.1It is well known that breastfeeding influences a child’s health positively andimproves nutritional status23.Breast milk is the best gift a mother can give her child.The WHO recommends that for the firstsix months of life, infants should be exclusively breastfed to achieve optimalgrowth and development.

The infants should thereafter, receive nutritionallyadequate and safe complementary foods, while continuing to breastfeed for up totwo years. 4  Exclusive Breast Feeding (EBF) isdefined as infant feeding with human milk without the addition of any otherliquids or solids. 5 The prevalence ofbreastfeeding differs from one country to another and from one society toanother, this is due to cultural and religious beliefs. 6  For all newborns, irrespective ofmode of delivery, especially those delivered by caesarean section, skin to skincontact should be initiated in about 5 minutes of birth. This early contactshould be continued till the first breastfeed is complete, this is calledBreast Crawl. This practice was initiated by IYCF & HMB guidelines (Infantand Young Child Feeding & Human Milk Banking Guidelines) in 2015.

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7  since the reflexes in the newborn are highlyactive in the first few minutes of delivery, especially those reflexes forfeeding, it is important that the bond between the mother and child for feedingis built in this crucial time.Colostrum is the first milk produced by the mammaryglands of mammals in late pregnancy just prior to giving birth and continuingthrough the early days of breastfeeding. 8 Thecolostrum feeding has significant effects for immediate and future health ofnewborn infants especially in developing countries that have high rates ofmalnutrition, infectious diseases and mortality for children under the age of 5years.910Colostrumis very rich in proteins, carbohydrates, vitamin A, and sodium chloride andcontains lower amounts of lipids and potassium than normal milk. It hasessential immunoglobulins which build the child’s immunity, hence can be calledas the 1st natural vaccine.

111213breastcrawl helps in receiving this essential colostrum.The prevalence of early breastfeedinghas remained low even though there has been adequate information to promote andsupport early breast feeding. 14 In India, breastfeeding appears to beinfluenced by social, cultural, and economic factors.

In 1991, BreastfeedingPromotion Network of India (BPNI) was introduced to protect, promote andsupport the practice breastfeeding.15  Furthermore,the Government of India has undertaken the National Rural Health Mission, whichis to implement Integrated Management of Neonatal and Childhood Illnesses(IMNCI) through the already existing healthcare delivery system.16  The promotionand acceptance of these practices, such as early breastfeeding and breast crawl,are specifically important in developing countries. While, a significant number ofstudies have been made to assess the knowledge, attitude and practice ofbreastfeeding in different parts of the world; such studies are low in numberamong Indian mothers.

There are not many reported studies of breast crawlknowledge and attitudes of mothers using the IIFAS (Iowa Infant FeedingAttitudes Scale) and IYCF & HMB guidelines from India. Moreover, maternalattitude is also a concept of interest to those who support breastfeeding. 7 17 18 19 20In this regard, we are proposing astudy to examine the knowledge, attitude and practices towards breast crawlamong Indian postnatal mothers’ using the IIFAS and IYCF & HMB guidelines.

Objectives:1.     To access the knowledge,attitude and practices of mothers, of rural parts of central Karnataka, regarding and breast crawl.2.      Todocument why the mothers are unable to practice breast crawl.Methodology:This is a cross-sectionalstudy. The study population comprises of post-natalmothers, who delivered and are admitted in Adichunchanagiri Hospital andResearch centre, B.

G. Nagar, Mandya district, Karnataka. Studyparticipants will be selected through a random sampling method of post-natalmothers admitted in the hospital. Those who meet the inclusion criteria will beinterviewed. The study criteria; a) Mothers of newly delivered healthy infants, b) Born between 37weeks and 42weeks ofgestation period, c) Without major birth defects such ascongenital heart disease, cleft lip/cleft palate, Down syndrome, etc. and d) Thosewho volunteer to participate.

 Mothers of preterm infants, and/or multiplegestations will be excluded. Approximately 200 postnatalmothers will be interviewed.After obtaining thepermission from the hospital authorities, all mothers participating will bebriefed about the purpose of the study.

Informed oral consent will be obtainedfrom each of the participants. A predesigned questionnaire will be administeredto the mothers. Data will be collected through a face-face interview. Patientconfidentiality will be maintained.

Neither the mother nor the child will beharmed in this study.Implication:This study will help usaccess the knowledge, attitude and practicing of breast crawl among mothers ofrural (central) Karnataka. With the above expected results we can plan onstrengthening the IYCF & HBM guidelines and educate more mothers about thepractice of breast crawl.  References:1.      Batal M, Boulghourjin C, AbdullahA, Afifi R.

Breast-feeding and feeding practices of infants in a developingcountry: A national survey in Lebanon. Public Health Nutr. 2005 (1);9:313–9.2.      Horta BL, Bahl R, Martines JC,Victora CG. Evidence on the long-term effects of breastfeeding: Systematicreviews and meta-analyses1. Last accessed on 17 July 2013.

3.      Van Rossum CT, Büchner FL, Hoekstra J. Quantificationof health effects of breastfeeding: Review of the literature and modelsimulation: RIVM report 350040001/2005. Bilthoven:RIVM; 2006.

4.      WHO. Exclusive breastfeeding for six months best for babieseverywhere’. World Health Organization; 2011. (Cited 2014 July 21).5.

     Gibney MJ, Elia M, Ljungqvist O, Dowsett J. Ch. 1.

 2nd ed. UK: Blackwell; 2006. ClinicalNutrition; p. 2.6.      Li R, Zhao Z, Mokdad A, Barker L, Grummer- Strawn L.Prevalence of breastfeeding in the United States: The 2001 National ImmunizationSurvey.

 Pediatrics. 2003;111:1198–201.7.      Infant and young child feeding & human milk bankingguidelines 2015. Page4 technical guidelines (c). 8.

     LaLeche League International. What Is Colostrum? How Does It Benefit My Baby? http://www.llli.org/faq/colostrum.html9.     Silva,P. (2005) Environmental Factors and Children’s Malnutrition in Ethiopia: PolicyResearch.

Working Paper Series No. 3489, The World Bank, Washington DC. 10.   Alemayehu, T., Haidar,J. and Habte, D. (2009) Determinants of Exclusive Breastfeeding Practices inEthiopia.

Ethiopian Journal of Health Development, 23, 12-18. http://dx.doi.org/10.4314/ejhd.

v23i1.4483211.  Ghai, O.P., Paul,V.

K. and Bagga, A. (2009) Textbook of Paediatrics. 7th Edition, CBC Publisherand Distributors, New Delhi, 768.12.   Heather Fisher SeniorThesis Project (2000) Colostrum: Properties, Functions, and Importance: TheRelationship between the Immunoglobulin Concentration in Holstein Colostrum andthe Total Senlm Protein in Holstein Heifer Calves.13.

  Science Daily(Homepage on the Internet). Colostrum.http://www.sciencedaily.

com/articles/c/colostrum.html14.  Global trends in breastfeeding. Cai X, Wardlow T, Brown DW.Int. Breastfeed J.

2012 sep 28; 7(1):1215.  BPNI: 10 years of its work. Gupta A. J Indian Med. Assoc.2002 Aug; 100(8);512-5.

16.  NRHM. National Rural Health Mission (2005–2012) Mission document. NewDelhi: MOHFW, Government of India, New Delhi; Ministry of Health and FamilyWelfare (MoHFW); 2006.17.

  Madhu K, Sriram C, Ramesh M. Breast Feeding Practices andNewborn Care in Rural Areas: A Descriptive Cross-Sectional Study. IndianJ Community Med. 2009;34:243–6.

18.  KhasawnetaM, Khadu Y, Amarin Z, Alkafeste A. Knowledge, attitude and practices ofbreastfeeding in the North Jordan. Int Breast FeedJ.

 2006;23:1–17.19.  Chaudhary RN, Shah T, Raja S.

Knowledge and practice ofmothers regarding breast feeding: A hospital based study. KnowlPract Breast Feed. 2011;9:194–200.20.  KishoreK.

Knowledge, Attitude and Practices of weaning among mothers in Gulbarga, MDthesis; Department of Paediatrics, MR Medical College, Gulbarga, Rajiv GandhiUniversity of Health Sciences; Karnataka, Bangalore. 2008. pp. 1–71.