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Fifteen-minute consultation: Breastfeeding in the first 2 weeks of life—a hospital perspective
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  • Published on: 18 January 2019
    The Let-Down reflex and milk supply

    The most recent Infant Feeding Survey (2010)1 showed that the most frequently given reasons for stopping breastfeeding in the second week were: insufficient milk (28%) and the baby being ‘too demanding’ or ‘always hungry’ (17%).
    Mothers and those advising them therefore should pay great attention to the milk supply.
    The breast is not a bottle, milk is transferred to the baby by the action of the all-important let-down reflex as the pulses of oxytocin reach the breast alveoli. This reflex governs not only milk delivery (transfer) to the baby but also has a significant role to play in milk production, there are many oxytocin receptors in the milk producing breast alveoli.
    I had looked at the factors affecting the let-down reflex and feeding patterns in the article I wrote for Acta Paediatrica2.
    I agree with Doctors Levene and O’Brien’s comment in Figure 1 that ‘longer feeds may mean baby is not feeding effectively’. We had found (in a different study3) that long feeds seemed to be associated with poor weight gain.

    1Infant Feeding Survey 2010. McAndrew.F. Thompson J. Fellows L et al. The information Centre for Health and Social Care 20.11.12
    2Are we getting the best from breastfeeding. Walshaw C.A. Acta Paediatr 2010 Sept j 99(9) 1292-7 doi 10.1111/j 1651-2227.2010.01812
    3 Does breastfeeding method influence infant weight gain? Walshaw CA. Owens JM. Scally AJ et al Arch Dis Chld 2008 Apr;93(4):292-6

    Conflict of Interest:
    None declared.
  • Published on: 18 January 2019
    Knowledge-Attitude-Practice gap in Breastfeeding Practices
    • Jogender Kumar, Neonatologist Post Graduate Institute of Medical education and Research, Chandigarh India 160012
    • Other Contributors:
      • Arushi Yadav, Doctor

    Dear Editor,
    We read with interest the article by Levene et al on the importance of breastfeeding and ways to improve it. [1] This article meticulously narrates the common barriers and possible solutions for them. It reminds me a famous quote by Keith Hansen “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics”. [2] The Lancet breastfeeding series [3] meticulously calculated the individual as well as global physical, social and economic benefits of the breastfeeding. Despite knowledge about the benefits of the breastfeeding, there is a wide gap in attitude and practice of it. It is one of the paradoxes positive health practice which is more common among the low-income countries than the richer ones. For example, in countries like Rwanda and Sri Lanka, the exclusive breastfeeding rates are as high as 85% and 76% respectively. [3] So, there is something beyond the knowledge alone, i.e. attitude towards breastfeeding which is not stressed much. To bridge this KAP gap for this novel cost-effective investment, we need to work on improving the attitude of mothers as well as healthcare professionals towards breastfeeding. A practical solution will be to do quality improvement studies using PDSA cycles at small scales and identify the barriers at that particular setup. It might be possible that the barriers across the countries are significantly different, in that case, “one model fits all” strateg...

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    Conflict of Interest:
    None declared.