World Breastfeeding Week – 1st August – 7th August 2023 

The World Health Organisation (WHO) suggests that exclusively breastfeeding a new born baby is the best way to ensure health and survival. Breastfeeding provides adequate nutrition and protection for a baby to grow during the first six months of life and is considered the gold standard.¹ 

Data suggests that whilst many mothers within the United Kingdom (U.K.) begin breastfeeding after birth, the percentage drops during the weeks after. Breastfeeding rates within the U.K. are generally lower than many other countries in Europe. Children’s charity UNICEF reports that higher rates of breastfeeding within the U.K. could lead to cost reductions for the National Health Service (NHS) by eliminating a large amount of childhood illnesses such as ear, chest, and gut infections. To support this claim, research suggests that breastfeeding can enhance immune development, protect against pathogens, colonise the gut, and lower the risk of gastrointestinal diseases. In addition to this, The Scientific Advisory Committee on Nutrition (SACN) advises that breastfeeding not only reduces risk of illness in babies, but in mothers, too.^2-4 

Nutritional benefits of breastmilk 

It is largely considered amongst scientists and health care professionals (HCPs) that ‘breast is best’. This is because breastmilk is very high in nutritional value and provides sufficient nutrients for an infant to grow and thrive. Breastmilk contains over 200 constituents, comprising of water (~90%), carbohydrates (lactose), protein, lipids, vitamins, and minerals. It also contains beneficial bacteria such as bifidobacterium, lactobacillus, and streptococcus. It is important to note that solely breastfed babies are often given 8.5 – 10mcg Vitamin D drops as a supplement as recommended by the SACN as this nutrient is often not obtained through breastmilk in sufficient amounts.^5-6 

The nutritional composition of breastmilk changes throughout the first ten days of feeding. The very first bit of milk produced by the mother is called colostrum and this is extremely rich in nutrients and the reason babies should be fed within the first hour of life. Furthermore, milk composition changes throughout the feed itself. Foremilk is expressed first to quench the babies thirst and hindmilk then follows to provide nutrition and energy.⁷ 

The current recommendations on breastfeeding  

The WHO currently recommends infants to be exclusively breastfed for the first six months of life as this meets all of their nutritional requirements.¹ As mentioned above, it is recommended that children are fed within the first hour of birth, known as early initiation of breastfeeding. Research suggests that babies that feed within one hour of birth compared to those that feed within two – twenty three hours post-birth have a 33% less risk of mortality.^8-9 

After six months, weaning can begin where solids such as mushy and pureed foods are introduced to the diet, whilst supplementing with breastmilk when needed. The WHO advises that breastmilk contributes 50% of nutritional needs after six months of life and up to twelve months, and then up to one third during the second year of life. Recommendations advise that mothers can continue breastfeeding their child for as long as they wish.¹ 

The NHS suggests ‘feeding on demand’. This means following the lead of the infant and feeding when they show signs of hunger, for example suckling, getting restless, and opening and closing their mouth.¹⁰ 

A dietitian’s role in supporting breastfeeding mothers  

Breastfeeding is considered the best form of nutrition for an infant; however, it does not provide any direct nutritional benefit to the mother and expends more calories throughout the day than usual. Alongside the extra energy demands, breastfeeding parents must also focus on consuming sufficient nutrients required, such as thiamine, niacin, folate, calcium, phosphorus, magnesium, zinc, copper, selenium, and vitamins A, B12, C, and D. A registered dietician can provide the support required to ensure that these micronutrients and enough energy is being consumed in large enough quantities to promote health and wellbeing.  

Despite the lack of nutritional benefit to mothers, there are other indirect benefits found with breastfeeding, for example skin to skin bonding between mother and baby stimulates the release of oxytocin. Oxytocin is one of the hormones responsible for the release of milk from the breast, often known as the ‘let-down reflex’.⁷ 

As breastfeeding can be demanding both nutritionally, physically, and emotionally, it is vital that parents receive sufficient support from all HPCs, including dieticians. The British Dietetic Association ‘strongly supports’ breastfeeding and encourages registered dieticians to provide midwives, health visitors, and family nurses the necessary support, knowledge, and information when it comes to breastfeeding. It is also recommended that all HCPs are UNICEF Baby Friendly Initiative accredited.^11-12 

Whilst research suggests that breastfed babies get the best nutritional start in life, there are numerous reasons as to why a mother may not be able to follow this path. The British Science Association reports that mothers in the United Kingdom (U.K.) are less likely to breastfeed compared to other countries, however, the reasons for this vary greatly including the inability for baby to latch, lack of support for new mothers, and societal pressures. A 2017 report proposes that breastfeeding rates are a ‘public health responsibility’ and that further Government-led strategies are imperative in improving the numbers.^13-14 

To protect parents, babies and HCPs, The International Code of Marketing Breast Milk Substitutes was introduced in 1981.¹⁵ It is an international health policy framework that aims to regulate the marketing and advertisement of breastmilk substitutes such as formula and other baby milk products. It aims to eliminate the risk of conveying a message that suggests formula is an equal replacement for breastmilk. However, for mothers that choose to make an informed decision to not breastfeed, or are unable to breastfeed, formula milk becomes essential to provide nutrition to their baby. It is then the role of a dietitian to provide evidence-based advice and information to ensure the most appropriate infant milk is used. Dieticians and other HCPs are unable to promote formula or provide samples due to the Code, however are able to provide guidance where necessary. Above all, all mothers and parents should be supported and respected throughout all decisions and choices.¹¹ 

References  

1. World Health Organization (2023) Breastfeeding [online]. Available at: https://www.who.int/health-topics/breastfeeding#tab=tab_1 [Accessed: 28 July 2023] 

2. Royal College of Paediatrics and Child Health (2021) RCPCH updates position statement on breastfeeding in the U.K. [online]. Available at: https://www.rcpch.ac.uk/news-events/news/rcpch-updates-position-statement-breastfeeding-uk [Accessed: 28 July 2023] 

3. UNICEF (2023) Breastfeeding in the U.K. [online]. Available at: https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/ [Accessed: 28 July 2023] 

4. SACN (2018) Feeding in the First Year of Life [online]. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/725530/SACN_report_on_Feeding_in_the_First_Year_of_Life.pdf (Accessed: 28 July 2023) 

5. Nutricia (2020) Change to importance and health benefits of breastfeeding: supporting parents [online]. Available at: https://www.nutricia.co.uk/hcp/where-we-specialise/infant-toddler-nutrition/breastfeeding.html [Accessed: 28 July 2023]  

6. SACN (2016) Vitamin D and Health [online]. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf [Accessed: 28 July 2023] 

7. World Health Organization (2009) Infant and Young Child Feeding [online]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148965/ [Accessed: 28 July 2023] 

8. UNICEF (2022) Breastfeeding [online]. Available at: https://data.unicef.org/topic/nutrition/breastfeeding/ [Accessed: 28 July 2023] 

9. Smith, E.R, et al (2017) Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis, Plos Medicine, Doi: 10.1371/journal.pone.0180722. [Accessed: 28 July 2023]  

10. NHS (2023) Feeding on Demand [online]/ Available at: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/bottle-feeding-your-baby/feeding-on-demand/#:~:text=Health%20professionals%20recommend%20%22responsive%22%20or,signs%20that%20they%20are%20hungry [Accessed: 28 July 2023] 

11. BDA (2018) Breastfeeding Policy Statement [online]. Available at: https://www.bda.uk.com/resource/breastfeeding-policy-statement.html [Accessed: 28 July 2023]  

12. UNICEF (2023) The Baby Friendly Initiative [online]. Available at: https://www.unicef.org.uk/babyfriendly/ [Accessed: 28 July 2023] 

13. British Science Association [2016] Breastfeeding rates in the U.K. are the lowest in the world [online]. Available at: https://www.britishscienceassociation.org/news/breastfeeding-rates-in-uk-are-the-lowest-in-the-world?gclid=CjwKCAjwzo2mBhAUEiwAf7wjkqj__PuwHGLdyQOSscByHhiqRcjHHclmQwpNb1qCQuvLd0bvvczr1hoCnAsQAvD_BwE [Accessed: 28 July 2023]  

14. Brown, A. (2017) Breastfeeding as a public health responsibility: a review of the evidence, Journal of Human Nutrition and Dietetics. PP. 677-799. Doi: 10.1111/jhn.12496 

15. World Health Organization (2017) The International Code of Marketing of Breast-Milk Substitutes [online]. Available at: https://apps.who.int/iris/bitstream/handle/10665/254911/WHO-NMH-NHD-17.1-eng.pdf [Accessed: 28 July 2023]